Pediatric Chronic Critical Illness: Training Teams to Address the Communication Challenges of Patients With Repeated and Prolonged Hospitalizations.

Context: Children with chronic critical illness (CCI) have repeated and prolonged hospitalizations. Discrete communication challenges characterize their inpatient care.

Objectives: Develop, implement, and evaluate a communication training for inpatient clinicians managing pediatric CCI.

Pediatric Chronic Critical Illness: Gaps in Inpatient Intrateam Communication.

Objectives: The number of children with medical complexity and prolonged hospitalizations is rising. Strategies to adapt acute care approaches for this population are falling behind clinical demand. This study aimed to identify how inpatient team communication practices match the needs of teams caring for these patients and families, and to identify priority areas for improvement.

Two cases of humoral hypercalcemia of malignancy complicating infantile fibrosarcoma.

We report two infants with infantile fibrosarcoma (IFS) complicated by severe hypercalcemia. Assessment demonstrated suppressed parathyroid hormone and 1,25-dihydroxyvitamin D levels with elevated circulating levels of parathyroid hormone related protein, indicating the diagnosis of humoral hypercalcemia of malignancy (HHM). HHM is a paraneoplastic syndrome rarely associated with pediatric malignancies.

Development and Validation of a Six-Item Version of the Interpersonal Dependency Inventory.

The Interpersonal Dependency Inventory (IDI) is a frequently used, 48-item measure of maladaptive dependency. Our goal was to develop and psychometrically evaluate a very brief version of the IDI. An exploratory factor analysis of the IDI in Study 1 ( N = 838) yielded a six-item IDI (IDI-6), with three items loading on an emotional dependency factor (IDI-6-ED), and the other three items loading on a functional dependency factor (IDI-6-FD).

Differential diagnosis of bipolar disorder and major depressive disorder.

Background: Patients with bipolar disorder spend approximately half of their lives symptomatic and the majority of that time suffering from symptoms of depression, which complicates the accurate diagnosis of bipolar disorder.

Methods: Challenges in the differential diagnosis of bipolar disorder and major depressive disorder are reviewed, and the clinical utility of several screening instruments is evaluated.

Results: The estimated lifetime prevalence of major depressive disorder (i.

The International Society for Bipolar Disorders (ISBD) task force report on antidepressant use in bipolar disorders.

Objective: The risk-benefit profile of antidepressant medications in bipolar disorder is controversial. When conclusive evidence is lacking, expert consensus can guide treatment decisions. The International Society for Bipolar Disorders (ISBD) convened a task force to seek consensus recommendations on the use of antidepressants in bipolar disorders.

Voluntary survey completion among team members: implications of noncompliance and missing data for multilevel research.

We explored whether voluntary survey completion by team members (in aggregate) is predictable from team members' collective evaluations of team-emergent states. In doing so, we reanalyze less-than-complete survey data on 110 teams from a published field study, using so-called traditional and modern missing data techniques to probe the sensitivity of these team-level relationships to data missingness. The multivariate findings revealed that a greater within-team participation rate was indeed related to a higher team-level (mean) score on team mental efficacy (across all four missing-data techniques) and less dispersion among team member judgments about internal cohesion (when the 2 modern methods were used).

Depression epidemiology and its treatment evolution.

Approximately 1 in 5 US adults have at least one episode of major depression in their lifetime. Of those who do, the majority will relapse over the long term and many will have psychosocial disabilities and reduced functioning. Over the past century, a range of medications have been developed to treat depression, although some effective medications have been superseded by newer treatments with an improved safety and tolerability profile.

The reality of teenage driving: the results of a driving educational experience for teens in the juvenile court system.

Background: In the United States, one third of all deaths in teens are a result of motor vehicle crashes, accounting for 6,000 deaths annually. Injury Free Coalition for Kids-Worcester in collaboration with Worcester Juvenile Court has developed an interactive program for first-time teenaged driving offenders, Reality Intensive Driver Education (Teen RIDE). This full-day program at the trauma center provides a realistic exposure to the consequences of risky driving behaviors.

The epidemiology of depression and the evolution of treatment.

Depression is a prevalent and pernicious disorder. About 1 in 5 US adults have at least 1 lifetime episode of major depression. Of those with depression, the majority will relapse over the long-term and many will have poor mental health outcomes and psychosocial disabilities.

A randomized, placebo-controlled, multicenter study of divalproex sodium extended-release in the acute treatment of mania.

Objective: Divalproex sodium extended-release (ER) was examined for the treatment of acute mania in adults in 2 randomized, placebo-controlled clinical trials. One study demonstrated statistically significant improvements in mania symptoms compared to placebo, while an earlier study did not. Results of the earlier study are presented here.

Bipolar disorder with frequent mood episodes in the national comorbidity survey replication (NCS-R).

Virtually nothing is known about the epidemiology of rapid cycling bipolar disorder (BPD) in community samples. Nationally representative data are reported here for the prevalence and correlates of a surrogate measure of DSM-IV rapid cycling BPD from the National Comorbidity survey Replication (NCS-R), a national survey of the US household population. DSM-IV disorders were assessed in the NCS-R with the WHO Composite International Diagnostic Interview (CIDI).

The effect of reduction and instrumentation of spondylolisthesis on spinopelvic sagittal alignment.

Background: Reduction of severe spondylolisthesis is controversial. Publications have emphasized the techniques of reduction and associated complications, but there is little knowledge about the effect of reduction on the sagittal balance of the spine and pelvis in the postoperative patient. This study evaluated the effect of surgical reduction and instrumented fusion of spondylolisthesis on the pelvic anatomy and spinopelvic sagittal balance.

Mental efficacy and physical efficacy at the team level: inputs and outcomes among newly formed action teams.

The authors demarcated mental efficacy and physical efficacy at the team level, and they explored these 2 factors as outcomes of 4 potential inputs and as predictors of 3 outcomes among 110 newly formed action teams in a military setting. Both types of team efficacy benefited from greater team size and an initial experience of enactive mastery, but they were not influenced by teams' female representation or knowledge pool. In terms of predictive contributions, both mental and physical efficacy facilitated internal social cohesion, yet only mental efficacy promoted problem solving and observed teamwork effectiveness.

Switching from other agents to extended-release carbamazepine in acute mania.

Background: There is a dearth of available knowledge relating to the efficacy of switching from one psychotropic agent to another in treating patients with acute mania.

Methods: This is a post hoc analysis of data from two randomized, placebo-controlled trials of carbamazepine extended-release capsules (CBZ-ERC) in the treatment of mania, to evaluate the efficacy of CBZ-ERC in patients previously nonresponsive to lithium (n 5 40), olanzapine (n 5 38), or valproate (VPA, n 5 77).

Results: In patients previously on lithium, Young Mania Rating Scale (YMRS) scores improved significantly from baseline to end point (27.

Diagnostic guidelines for bipolar depression: a probabilistic approach.

Objectives: There are currently no accepted diagnostic criteria for bipolar depression for either research or clinical purposes. This paper aimed to develop recommendations for diagnostic criteria for bipolar I depression.

Methods: Studies on the clinical characteristics of bipolar and unipolar depression were reviewed.

Awareness of the metabolic syndrome in patients with bipolar disorder: A comparison of US and European psychiatrists.

Introduction. The metabolic syndrome is a relatively new concept still being debated in the US and Europe; little is known about how it is factored into psychiatric treatment decisions. Method.

Screening for bipolar disorder.

Bipolar disorder is a recurrent and sometimes chronic illness involving episodes of depression and mania or hypomania. The most frequent presentation is depression: more than 1 of 5 primary care patients with depression have bipolar disorder. The symptoms of bipolar depression often differ from those of unipolar depression.

Defining the clinical course of bipolar disorder: response, remission, relapse, recurrence, and roughening.

Objective: This manuscript presents working definitions for key clinical course indicators for bipolar disorder, including response, remission, relapse, recurrence, and roughening.

Method: A work group of experts in bipolar disorder reviewed prior efforts to define clinical course indicators for unipolar depression and for schizophrenia. Using these efforts as templates, the work group developed consensus operational definitions.