Child mental health treatment access and retention in integrated primary care and traditional outpatient services.

Introduction: There are disparities in child mental health treatment access and treatment retention in terms of race and ethnicity, socioeconomic status (SES), and insurance coverage. Institutions have invested in the integrated primary care (IPC) treatment model with the goal of improving treatment access and promoting child mental health equity.

Objective: This study compared treatment attendance in an outpatient psychiatry clinic (OPC) versus an IPC clinic to assess whether the IPC was associated with reduced disparities in access to care and treatment retention.

TORC1/2 kinase inhibition depletes glutathione and synergizes with carboplatin to suppress the growth of MYC-driven medulloblastoma.

Medulloblastoma is the most common malignant pediatric brain tumor. Tumors having high levels of c-MYC have the worst clinical prognosis, with only a minority of patients surviving. To address this unmet clinical need, we generated a human neural stem cell model of medulloblastoma that recapitulated the most aggressive subtype phenotypically and by mRNA expression profiling.

Safety and efficacy of a pharmaco-invasive reperfusion strategy in rural ST-elevation myocardial infarction patients with expected delays due to long-distance transfers.

Aims: To determine the safety and efficacy of a pharmaco-invasive reperfusion strategy utilizing half-dose fibrinolysis combined with transfer for immediate percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) patients presenting to remote rural hospitals. Primary PCI is preferred for STEMI if performed in a timely manner. However, <20% of STEMI patients transferred for PCI in the USA have door-to-balloon times <2 h.

Evolution of hemodialysis access resistance: a longitudinal 5-year model using functional principal components analysis.

Purpose: Arteriovenous fistulae (AVF) and grafts (AVG) are the preferred accesses in hemodialysis (HD). By monitoring access resistance (AR) one can potentially identify problems with an established HD access, but little is known about how these changes in AR occur, or the variations between the two access types as they mature longitudinally. We postulated that AR evolves differentially between AVF and AVG, a critical aspect to further understanding of the natural history of HD accesses.

A regional system to provide timely access to percutaneous coronary intervention for ST-elevation myocardial infarction.

Background: Percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) is superior to fibrinolysis when performed in a timely manner in high-volume centers. Recent European trials suggest that transfer for PCI also may be superior to fibrinolysis and increase access to PCI. In the United States, transfer times are consistently long; therefore, many believe a transfer for PCI strategy for STEMI is not practical.

Risperidone monotherapy for post-traumatic stress disorder related to sexual assault and domestic abuse in women.

Post-traumatic stress disorder is a common, chronic, and often disabling mental illness. Selective serotonin reuptake inhibitors are the usual first-line treatment for post-traumatic stress disorder, but many patients fail to respond adequately. Thus, other treatment options, including the atypical antipsychotics such as risperidone, need to be tested.

Radiation following percutaneous balloon aortic valvuloplasty to prevent restenosis (RADAR pilot trial).

Objectives: We wished to determine the feasibility and early safety of external beam radiation therapy (EBRT) used following balloon aortic valvuloplasty (BAV) to prevent restenosis.

Background: BAV for calcific aortic stenosis (AS) has been largely abandoned because of high restenosis rates, i.e.

Limited flow reserve in non-obstructed bypass grafts supplying infarcted myocardium: implications for cardiovascular magnetic resonance imaging protocols.

We evaluated flow reserve in non-obstructed bypass grafts supplying infarcted and noninfarcted myocardium. Bypass grafts were examined by phase-contrast flow measurements and myocardial viability was assessed with late enhancement technique. Flow reserve was higher in bypasses supplying normal myocardium compared to those supplying infarcted myocardium (2.

Proteinuria and risk for stroke and coronary heart disease during 27 years of follow-up: the Honolulu Heart Program.

Background: Urinary protein excretion has been linked to coronary heart disease (CHD); the relationship to stroke is less clear. We assessed whether urine dipstick screening for protein predicted stroke and CHD in the Honolulu Heart Program cohort.

Methods: Prospective, observational study of 6252 Japanese American men in Honolulu aged 45 to 68 years.

Design of a standardized system for transfer of patients with ST-elevation myocardial infarction for percutaneous coronary intervention.

Background: Direct percutaneous coronary intervention (PCI) is the preferred method of reperfusion for ST-elevation myocardial infarction (STEMI). Transfer from community hospitals to PCI centers increases availability for direct PCI, which improves outcomes compared to fibrinolysis in Europe. It has been difficult to achieve similar door-to-balloon times for transfer patients in the United States.

New ACGME work-hour guidelines and their impact on current residency training practices.

Objective: Accreditation Council for Graduate Medical Education (ACGME) has introduced new work-hour guidelines for residents in ACGME accredited programs that were implemented in July 2003. The new ACGME policies impact several practices in various psychiatry residency programs across the U.S.

Bleeding risk in patients with underlying chronic kidney disease admitted for acute coronary syndromes.

A retrospective review of 200 patients with acute coronary syndrome (ACS) and chronic kidney disease (CKD) was compared to 200 patients without CKD to investigate the incidence of bleeding. Logistic regression analysis identified CKD as an independent risk factor for bleeding (OR 1.82, 95% CI 1.

Gender differences in therapy for patients admitted for unstable angina and myocardial infarction with underlying chronic kidney disease.

We examined treatment patterns of female pts with CKD admitted for ACS. In this retrospective review of 200 patients with chronic kidney disease presenting with acute coronary syndrome, we found that females patients were less likely to receive aspirin and ACE-inhibitors and there was a trend towards less frequent use of coronary angiography

Severity of chronic kidney disease did not influence bleeding during treatment of acute coronary syndromes.

We assessed the influence of CKD on bleeding in 200 patients with ACS via retrospective chart analysis. Using K/DOQI guidelines to stratify patients based on GFR, no differences in documented bleeding or antithrombotic utilization were observed among the groups. Due to increased mortality risk of patients with CKD from cardiovascular disease, assessing benefit-to-risk ratios of various medical interventions is crucial.

Management of patients with chronic kidney disease presenting with acute coronary syndrome.

We evaluated the treatment pattern of patients with chronic kidney disease presenting with acute coronary syndromes. In a retrospective chart review of 400 patients with and without kidney disease presenting with angina pectoris we found that patients with chronic kidney disease have longer hospital stays, receive fewer diagnostic angiographies, and have a delay in therapy.

Addiction training scale: pilot study of a self-report evaluation tool for psychiatry residents.

Objective: Alcohol and drug dependence disorders have become common public health hazards. Psychiatrists encounter these problems in a major portion of their patients. However, recent data suggest that their training does not provide them the confidence to treat these disorders.

Patient and physician attitudes to using medications with religiously forbidden ingredients.

Background: Over 1000 medications contain pork- and/or beef-derived gelatin and stearic acid as inert ingredients. Use of these medications in patients with religious beliefs against consumption of these ingredients might constitute an ethical conflict.

Objective: To assess patients' and physicians' attitudes about using medications with religiously prohibited ingredients derived from pork and/or beef.

Image guided I125 prostate brachytherapy with Hybrid Interactive Mick technique in the community setting: How does it compare?

The aim of this study is to evaluate the target coverage, procedural techniques, and merits of Hybrid Interactive Mick (HIM) I125 transperineal permanent implantation (TPPI) of the prostate performed with 10 urologists in a community hospital. Detailed day 0 post-implant dosimetric evaluations of TPPI procedures were performed on 333 consecutive monotherapy patients treated between September 2000 and November 2003 at a single institution. All patients underwent TPPI with HIM.

The validity of subjective measures of body image disturbance.

Objective: We examined weight dissatisfaction (actual weight minus self-stated ideal weight) and weight goal (normative weight minus self-stated ideal weight) subjective indices in a large clinical sample to determine how the indices discriminate between diagnostic categories and relate to other measures of body image disturbance.

Method: Approximately 200 anorexic, bulimic, and eating disorder not otherwise specified (NOS) participants reported their self-stated ideal weight and completed the Mizes Anorectic Cognitions (MAC) Questionnaire, Eating Disorders Inventory (EDI), and Restraint Scale-Revised.

Results: Compared with bulimic and NOS participants, anorexics reported less weight dissatisfaction but had an ideal weight that is farthest from normative weight.

Infective endocarditis in patients with end-stage renal disease: clinical presentation and outcome.

Background: Infective endocarditis is a common complication of vascular access in patients undergoing long-term hemodialysis. However, available data are either dated or gathered from small samples. The goal of this study was to investigate the clinical characteristics and outcome of infective endocarditis occurring in patients with end-stage renal disease.

Clinical, angiographic, and interventional follow-up of patients with aortic-saphenous vein graft connectors.

Background: The use of aortic connectors for proximal saphenous vein bypass graft anastomoses eliminates the need for aortic clamping during coronary artery bypass grafting (CABG) and may reduce the incidence of stroke in the elderly and in patients with severe aortic atherosclerosis.

Methods And Results: We studied 74 consecutive patients who received the Symmetry Bypass System aortic connector at the time of CABG. A total of 131 of 144 proximal vein graft anastomoses were performed with this device.