Pharmacotherapy and Ketamine Assisted Psychotherapy for Treatment-Resistant Depression: A Patient With Lifelong Self-Doubt and Self-Criticism.

Although consensus in the field is lacking, the most common definition for treatment-resistant depression (TRD) requires a minimum of 2 prior treatment failures with confirmed adequate dose and duration. This article presents a clinical example of TRD in a patient with a long history of depression and inadequate response to treatment. The prominent feature is the patient's persistent self-criticism that might have predisposed him to unrelenting depression symptoms, intense anger, self-doubt, and self-disapproval.

Reach in a pragmatic hypertension trial: A critical RE-AIM component.

Background: Hypertension control is falling in the US yet efficacious interventions exist. Poor patient reach has limited the ability of pragmatic trials to demonstrate effectiveness. This paper uses quantitative and qualitative data to understand factors influencing reach in Hyperlink 3, a pragmatic hypertension trial testing an efficacious pharmacist-led Telehealth Care intervention in comparison to a physician-led Clinic-based Care intervention.

Psychotherapy for Functional Neurological (Conversion) Disorder: A Case Bridging Mind, Brain, and Body.

Functional neurologic (conversion) disorder (FND) is a core neuropsychiatric condition directly at the intersection of psychiatry and neurology. Over the past several decades, renewed interest in FND has been catalyzed by use of a "rule-in" diagnostic approach leveraging positive clinical signs specific for the diagnosis. In parallel, advances have occurred in identifying mechanisms, etiologic factors, and evidence-based treatments for this population.

Neural predictors of successful brief psychodynamic psychotherapy for persistent depression.

Background: Psychodynamic psychotherapy has been used to treat depression for more than a century. However, not all patients respond equally well, and there are few reliable predictors of treatment outcome.

Methods: We used resting (18)F-fluorodeoxyglucose positron emission tomography ((18)FDG-PET) scans immediately before and after a structured, open trial of brief psychodynamic psychotherapy (n = 16) in conjunction with therapy process ratings and clinical outcome measures to identify neural correlates of treatment response.

The effect of depression treatment on work productivity.

Objectives: Depression is associated with lowered work functioning, including absence, productivity impairment at work, and decreased job retention. Although high-quality depression treatment provided in clinical trials has been found to reduce symptoms and improve work function, the effectiveness of routine treatment for depression in primary care has received less attention.

Study Design: This prospective cohort study investigated the relationship between improvements in both depression symptoms and productivity in outpatients from 77 clinics in Minnesota following routine depression treatment.

Variation in quality of diabetes care at the levels of patient, physician, and clinic.

Introduction: We studied variance in glycated hemoglobin (HbA1c) values among adults with diabetes to identify variation in quality of diabetes care at the levels of patient, physician, and clinic, and to identify which levels contribute the most to variation and which variables at each level are related to quality of diabetes care.

Methods: Study subjects were 120 primary care physicians and their 2589 eligible adult patients with diabetes seen at 18 clinics. The dependent variable was HbA1c values recorded in clinical databases.

Stereoselective synthesis of sugar-modified enyne analogues of adenosine and uridine. Interaction with S-adenosyl-L-homocysteine hydrolase and antiviral and cytotoxic effects.

Sonogashira coupling of (E)-6'-iodohomovinyl nucleosides 1 with (trimethylsilyl)acetylene gave the conjugated 8'-(trimethylsilyl)enyne derivatives of the adenosine 2a and uridine 2b with expected E-stereochemistry. Desilylation of 2a,b with tetrabutylammonium fluoride followed by treatment with N-iodosuccinimide/AgNO(3) afforded 8'-iodoenynes 4a,b. Analogous coupling of (Z)-6'-iodohomovinyl nucleosides 7a,b produced (Z)-8'-(trimethylsilyl)enynes 8a,b, which were deprotected with aqueous trifluoroacetic acid to give the Z-enynes 9a,b.

Stereocontrolled synthesis of diene and enyne sugar-modified nucleosides and their interaction with S-adenosyl-L-homocysteine hydrolase.

Conjugated diene 5-7 and enyne 8 analogs derived from adenosine and uridine were synthesized employing Pd-catalyzed cross-coupling reactions.

Point-of-care versus laboratory measurement of the International Normalized Ratio.

The Notes section welcomes the following types of contributions: (1) practical innovations or solutions to everyday practice problems, (2) substantial updates or elaborations on work previously published by the same authors, (3) important confirmations of research findings previously published by others, and (4) short research reports, including practice surveys, of modest scope or interest. Notes should be submitted with AJHP's manuscript checklist. The text should be concise, and the number of references, tables, and figures should be limited.

The prediction of long-term functional outcomes of children with cerebral palsy.

Current information was obtained from 117 respondents, including 71 who completed interviews, of a population of 810 individuals who had been diagnosed with cerebral palsy between 1951 and 1974. Original chart reviews constituted the basis for predicting employment capabilities of the interviewed cohort. A comparison of predictions with actual functional outcomes demonstrated a tendency to pessimistic underestimation of long-term functional outcome, sounding a note of caution to paediatric developmentalists.

Overlooking: a sign of bilateral central scotomata in children.

Four children are reported who always looked above objects of visual interest (overlooking). All had bilateral central scotomata (loss of central visual field). Three had optic nerve disease selectively affecting the papillomacular fibers; the fourth had ocular colobomata affecting the maculae.

Home care for ventilator-dependent children. Psychosocial impact on the family.

The impact of providing home care for ventilator-dependent children was studied in a cross-sectional survey of 18 northern California families. Through the use of a confidential structured interview and the impact on Family Scale, we obtained information on family demographics; the childrens' medical conditions; financial, social, and personal impact on the family; and parental coping-mastery of the care of a ventilator-dependent child at home. Analysis of scores from the impact on Family Scale showed no differences in the perceived family impact between primary caretakers and their spouses.

Health care needs and services for technology-dependent children in developmental centers.

In an attempt to document the trend toward a more seriously ill and medically needy population of children in California state developmental centers, we studied the medical status and health care needs of the pediatric and young adult population (birth to 22 years of age) residing in all acute care and skilled nursing care units in developmental centers in 1988. All children in California's state developmental centers are severely to profoundly mentally retarded and chronically disabled, and many have serious health problems. Of the 865 children in 5 developmental centers, 441 (51%) resided in acute and skilled nursing care units and were technology dependent (Office of Technology Assessment classification).

Nail dysplasia and fetal alcohol syndrome. Case report of a heteropaternal sibship.

We found substantial dysplasia of fingernails and toenails in each of four siblings demonstrating other features consistent with a diagnosis of fetal alcohol syndrome (FAS). This aspect of examination is frequently overlooked in routine physical assessments. All four affected teenagers of this heteropaternal sibship demonstrated common features of FAS, including moderate mental retardation, maxillary hypoplasia, an elongated philtrum, and narrow palpebral fissures, as well as absence or dysplasia of two or more nails.

Utilization of exogenously added acetyl coenzyme A by intact isolated lysosomes.

Acetyl coenzyme A has been shown to be required for heparan sulfate degradation for the acetylation of terminal alpha-linked glucosamine residues (Klein, U., Kresse, H., and von Figura, K.

Degradation of mucopolysaccharide in intact isolated lysosomes.

The function of isolated lysosomes was studied by measuring mucopolysaccharide degradation. Cultured human diploid skin fibroblasts were grown in medium containing H235SO4 to label endogenous mucopolysaccharide. Lysosome containing preparations at various stages of purity were isolated from disrupted cells.

The effects of primary care versus traditional training on career choice in pediatrics.

In response to concerns questioning the relevance for future pediatric generalists of traditional hospital-based, subspecialty-oriented pediatric residency training, new residency programs emphasizing increased ambulatory, continuity care training experiences have been developed.We compared the career activities of physicians who had received their pediatric residency training in the traditional, predominantly inpatient program and in the predominantly ambulatory primary care program at the University of California, San Francisco. Three groups were surveyed: (1) pre-1975, those who received training in the traditional program before 1975, (2) post-1975, those who were trained in the traditional program after 1975 and (3) primary care, those who received their training in the primary care program beginning in 1975.

Medical and health care in state residential institutions for children and youths. A report of survey findings in five hospitals. The Committee on Children with Handicaps, Northern California Chapter, American Academy of Pediatrics.

A survey of five Northern California state residential institutions showed considerable variation in the type and amount of medical services provided for children and youths. There was no standard policy for relationships with regional centers, use of community hospitals, vision and hearing assessments, speech and rehabilitation therapy, or genetic and maternal health services. Some hospitals had no staff members certified to carry out cardiopulmonary resuscitation (CPR).