Collaborative Care for Depression in Primary Care: How Psychiatry Could “Troubleshoot” Current Treatments and Practices

The bulk of mental health services for people with depression are provided in primary care settings. Primary care providers prescribe 79 percent of antidepressant medications and see 60 percent of people being treated for depression in the United States, and they do that with little support from specialist services. Depression is not effectively managed in the primary care setting. Collaborative care based on a team approach, a population health perspective, and measurement-based care has been proven to treat depression more effectively than care as usual in a variety of settings and for different populations, and it increases people’s access to medications and behavioral therapies. Psychiatry has the responsibility of supporting the primary care sector in delivering mental health services by disseminating collaborative care approaches under recent initiatives and opportunities made possible by the Affordable Care Act (ACA).     

Long-Term Care Facilities: Important Participants of the Acute Care Facility Social Network?

Background

Acute care facilities are connected via patient sharing, forming a network. However, patient sharing extends beyond this immediate network to include sharing with long-term care facilities. The extent of long-term care facility patient sharing on the acute care facility network is unknown. The objective of this study was to characterize and determine the extent and pattern of patient transfers to, from, and between long-term care facilities on the network of acute care facilities in a large metropolitan county.

Methods/Principal Findings

We applied social network constructs principles, measures, and frameworks to all 2007 annual adult and pediatric patient transfers among the healthcare facilities in Orange County, California, using data from surveys and several datasets. We evaluated general network and centrality measures as well as individual ego measures and further constructed sociograms. Our results show that over the course of a year, 66 of 72 long-term care facilities directly sent and 67 directly received patients from other long-term care facilities. Long-term care facilities added 1,524 ties between the acute care facilities when ties represented at least one patient transfer. Geodesic distance did not closely correlate with the geographic distance among facilities.

Conclusions/Significance

This study demonstrates the extent to which long-term care facilities are connected to the acute care facility patient sharing network. Many long-term care facilities were connected by patient transfers and further added many connections to the acute care facility network. This suggests that policy-makers and health officials should account for patient sharing with and among long-term care facilities as well as those among acute care facilities when evaluating policies and interventions.     

Pair‐living in the Absence of Obligate Biparental Care in a Lizard: Trading‐off Sex and Food?

A pair‐living social organisation can typically be explained by obligate biparental care. We investigated pair‐living in the absence of biparental care in the Australian sleepy lizard, Tiliqua rugosa, which forms exceptionally strong pair bonds. We fitted 10 lizards, five male–female pairs, with Global Positioning System (GPS) recorders and continuously monitored social associations and separations between active pair partners, based on location records taken every 10 min over 3 mo. Males temporarily separated and reunited the pair more frequently than females, but females also contributed to the maintenance of the pair bond. These behavioural data were consistent with the hypothesis that females successfully coerce males into associations with one female. Lower frequencies of social association between pair partners once mating had finished support this interpretation. Males that are coerced into pair associations appear to experience higher costs of pair‐living than females, because males initiated temporary separations of the pair more frequently than females. Males showed higher movement activity and remained active later each day. This sex bias in activity may be an important mechanism to mitigate the higher costs of pair‐living for males. Costs for males might include within‐pair competition for food as females appear more competitive. Our study provides detailed empirical data on a lizard pair bond and provides important insights into pair‐living in the absence of biparental care.     

Care of HIV-infected patients in China

INTRODUCTION Compared with other areas with high HIV infection rate in the world, the total HIV infection rate in China is rela- tively low. Nonetheless, in light of China’s vast territory and large population, the potential infection risk must be taken …     

Do Birdwatchers Care about Bird Disturbance?

ABSTRACT

Little is known about how non-consumptive recreationists perceive their impacts on animals and how this relates to recreationist behavior. We surveyed attitudes and behaviors relating to bird disturbance of 179 birdwatchers who visited a world-renowned, restricted-access birdwatching destination (the Western Treatment Plant [WTP], Victoria, Australia). We distributed a 10-page, 49-question survey to birdwatchers at the WTP and posted it to a mailing list of those who held birdwatching access permits. The questionnaire explored socio-demographic profiles of respondents, and their bird- watching behaviors and attitudes to bird disturbance. Birdwatchers regarded vehicles as particularly disturbing and some bird groups, and breeding birds, as especially sensitive to disturbance. They generally disagreed with the contention that birdwatchers and plant workers disturb birds. All respondents reported using strategies to mitigate bird disturbance (e.g., keeping quiet and distant). Those who adopted more strategies to mitigate disturbance agreed more with the contention that birdwatchers and workers cause disturbance, and that breeding birds are especially sensitive to disturbance. Our results suggest that birdwatchers who perceive that their activity disturbs birds are more likely to modify their behaviors to minimize the disturbance. As such, wildlife managers and educators must clearly communicate possible impacts of birdwatching to birdwatchers to maximize the uptake of ethical birdwatching practices.     

GASTRIC RESECTION—Preoperative and Postoperative Care

Perhaps in no other field of surgery does attention to minute detail play so important a role in determining success as it does in gastric operations.As surgery of the stomach develops toward even greater security and favorable results can be expected with greater confidence, the several aspects of preoperative and postoperative care hitherto regarded as secondary demand closer consideration.     

Fragmentation of Care Threatens Patient Safety in Peripheral Vascular Catheter Management in Acute Care– A Qualitative Study

Background

The use of peripheral vascular catheters (PVCs) is an extremely common and necessary clinical intervention, but inappropriate PVC care poses a major patient safety risk in terms of infection. Quality improvement initiatives have been proposed to reduce the likelihood of adverse events, but a lack of understanding about factors that influence behaviours of healthcare professionals limits the efficacy of such interventions. We undertook qualitative interviews with clinical staff from a large group of hospitals in order to understand influences on PVC care behaviors and subsequent patient safety.

Methods

Ten doctors, ten clinical pharmacists, 18 nurses and one midwife at a National Health Service hospital group in London (United Kingdom) were interviewed between December 2010 and July 2011 using qualitative methods. Responses were analysed using a thematic framework.

Results

Four key themes emerged: 1) Fragmentation of management and care, demonstrated with a lack of general overview and insufficient knowledge about expected standards of care or responsibility of different professionals; 2) feelings of resentment and frustration as a result of tensions in the workplace, due to the ambiguity about professional responsibilities; 3) disregard for existing hospital policy due to perceptions of flaws in the evidence used to support it; and 4) low-risk perception for the impact of PVC use on patient safety.

Conclusion

Fragmentation of practice resulted in ill-defined responsibilities and interdisciplinary resentment, which coupled with a generally low perception of risk of catheter use, appeared to result in lack of maintaining policy PVC standards which could reduced patient safety. Resolution of these issues through clearly defining handover practice, teaching interdisciplinary duties and increasing awareness of PVC risks could result in preventing thousands of BSIs and other PVC-related infections annually.     

Are Patents Impeding Medical Care and Innovation?

Background to the debate: Pharmaceutical and medical device manufacturers argue that the current patent system is crucial for stimulating research and development (R&D), leading to new products that improve medical care. The financial return on their investments that is afforded by patent protection, they claim, is an incentive toward innovation and reinvestment into further R&D. But this view has been challenged in recent years. Many commentators argue that patents are stifling biomedical research, for example by preventing researchers from accessing patented materials or methods they need for their studies. Patents have also been blamed for impeding medical care by raising prices of essential medicines, such as antiretroviral drugs, in poor countries. This debate examines whether and how patents are impeding health care and innovation.     

Coronary Care Units—The Status in California

In order to determine the status of Coronary Care Unit activity in California hospitals, especially as it pertains to nurse training, a survery was conducted by the California State Department of Public Health. More than 95 percent of hospitals that were questioned responded. Only one-third of the hospitals reported they neither had a unit nor plans to build one. All units in operation were either directed by an individual medical director or by a Coronary Care Unit Committee.The survey indicated that in some hospitals with operational units, nurses were not permitted to perform life-saving resuscitative procedures. All operational units reported in-service education programs of some type. Many hospitals indicated they would like to have Coronary Care Unit training programs to which they could send nurses. The reasons why nurses may not perform important resuscitative procedures are discussed as well as the need for Coronary Care Unit training programs for both physicians and nurses in California.     

Geriatric Patients: Do Their Families Care?

A study of the reasons for admission of 280 patients from their own homes to a geriatric unit in the East End of Glasgow showed that in two-thirds of cases patients were admitted primarily because they failed to receive adequate basic care at home (usually because of lack of relatives) or because their relatives suffered undue strain in caring for them. Neglect by relatives played a negligible part in the need for admission.     

The Diagnostic Value of (1 → 3)-Beta-<Emphasis Type="SmallCaps">d</Emphasis>-glucans and Galactomannan Assays in Children Suffering from Bacteremia in Pediatric Intensive Care Unit

The value of (1 → 3)-beta-d-glucans (BG) and galactomannan (GM) assays on diagnostic invasive fungal infections (IFIs) has been observed in adult ICU and in children with hematological malignancies. Only scant data evaluated non-hematological in pediatric intensive care unit (PICU). Here, we retrospectively analyzed the role of bacterial infection to the reactivity of BG and GM assays in PICU. The results showed that the overall prevalence of bacteremia was 13.8% (65/470). The most common underlying disease was pneumonia (81.8%), followed by congenital heart disease (43.2%). The median levels of GM and range for each group [A: without bacterial infection nor IFIs (n = 151); B, patients with bacterial infection (n = 36); C, patients with bacterial infection and IFIs (n = 8)] were, respectively: 0.14 (0.01–1.34), 0.21 (0.06–1.34), 0.14 (0.02–0.99). No significant difference was found among three groups (P = 0.66). The median levels of BG and range for each group (A, B, C) were, respectively: 50.00 pg/mL (16.20–548.20 pg/mL), 50.00 pg/mL (16.10–597.60 pg/mL), 268.7 pg/mL (50.9–4224.00 pg/mL). Patients with bacteremia and IFIs showed significantly higher BG levels than these who with or without bacteremia (P = 0.003), but there was no significant difference between control subjects and patients with bacteremia group. We also observed the GM and BG levels in Gram-negative and Gram-positive groups. No significant difference was found between two groups. In conclusions, the results showed that bacteremia was unlikely cause of false-positive results of the BG and GM assays in PICU.     

United States Acculturation and Cancer Patients’ End-of-Life Care

Background

Culture shapes how people understand illness and death, but few studies examine whether acculturation influences patients’ end-of-life treatment preferences and medical care.

Methods and Findings

In this multi-site, prospective, longitudinal cohort study of terminally-ill cancer patients and their caregivers (n = 171 dyads), trained interviewers administered the United States Acculturation Scale (USAS). The USAS is a 19-item scale developed to assess the degree of “Americanization” in first generation or non-US born caregivers of terminally-ill cancer patients. We evaluated the internal consistency, concurrent, criterion, and content validity of the USAS. We also examined whether caregivers’ USAS scores predicted patients’ communication, treatment preferences, and end-of-life medical care in multivariable models that corrected for significant confounding influences (e.g. education, country of origin, English proficiency). The USAS measure was internally consistent (Cronbach α = 0.98); and significantly associated with US birthplace (r = 0.66, P<0.0001). USAS scores were predictive of patients’ preferences for prognostic information (AOR = 1.31, 95% CI:1.00–1.72), but not comfort asking physicians’ questions about care (AOR 1.23, 95% CI:0.87–1.73). They predicted patients’ preferences for feeding tubes (AOR = 0.68, 95% CI:0.49–0.99) and wish to avoid dying in an intensive care unit (AOR = 1.36, 95% CI:1.05–1.76). Scores indicating greater acculturation were also associated with increased odds of patient participation in clinical trials (AOR = 2.20, 95% CI:1.28–3.78), compared with lower USAS scores, and greater odds of patients receiving chemotherapy (AOR = 1.59, 95% CI:1.20–2.12).

Conclusion

The USAS is a reliable and valid measure of “Americanization” associated with advanced cancer patients’ end-of-life preferences and care. USAS scores indicating greater caregiver acculturation were associated with increased odds of patient participation in cancer treatment (chemotherapy, clinical trials) compared with lower scores. Future studies should examine the effects of acculturation on end-of-life care to identify patient and provider factors that explain these effects and targets for future interventions to improve care (e.g., by designing more culturally-competent health education materials).