Electroconvulsive Therapy in a Left Ventricular Assist Device Recipient With Treatment-Resistant Depression.

Depression and heart failure are highly comorbid, with up to 35% of heart failure patients suffering from comorbid depression. Left ventricular assist devices (LVADs) serve as a major lifeline for patients with heart failure; however, despite the drastic improvement in cardiac function following LVAD implantation, up to 24% of LVAD recipients suffer from depression. Depression management in LVAD recipients is often complicated by the recipient's increased risk for antidepressant side effects, adverse drug reactions, and inability to safely receive certain interventional psychiatry therapies, as the LVAD is either a relative or absolute contraindication.

The Cost of Mental Health Comorbid Conditions in Burn Patients: A Single-site Experience.

Many burn survivors suffer from psychiatric sequelae long after their physical injuries have healed. This may even be more pronounced in individuals who have a history of mental health disorders prior to admission. The aim of this study was to explore the clinical outcomes of patients with previously diagnosed mental health disorders who were admitted to our Burn Center.

Implementation of a Psychiatry Consultation-Liaison Service "Conseminar".

Background: The field of consultation-liaison psychiatry has generated a relatively small number of rigorous clinical trials that guide clinical care. Consequently, there is a need for a consensus-building process to inform best practices for common clinical dilemmas in consultation-liaison psychiatry.

Objective: We review several consensus-building approaches in academic medicine and describe a novel educational process called a "conseminar," which is intended to minimize the variability in teaching and practice on a service staffed by multiple faculty members.

Association Between Alcohol, Substance Use, and Inpatient Burn Outcomes.

The use of alcohol and illicit substances has been associated with impaired judgment and health, but the effect on inpatient outcomes after burn injury remains unsettled. Our objective was to evaluate the effect of alcohol and illicit substance use on our inpatient burn outcomes. Adult patients admitted with burn injury-including inhalation injury only-between January 1, 2014 and June 30, 2019 were eligible for inclusion.

Neuropsychiatric Complications of COVID-19.

Purpose Of Review: To describe the presentation, etiologies, and suggested management of post-acute COVID-19 neuropsychiatric symptoms.

Recent Findings: Over 30% of patients hospitalized with COVID-19 may exhibit cognitive impairment, depression, and anxiety that persist for months after discharge. These symptoms are even more common in patients who required intensive care for severe effects of the virus.

Bias in alcohol and drug screening in adult burn patients.

Alcohol and illicit drug use are common among burn-injured patients. Urine toxicology and alcohol screens are a part of our admission order sets and automatically ordered for all adult patients. Our objective was to determine the impact of bias in screening compliance and compare those results to patients who test positive.

Burn recidivism: a 10-year retrospective study characterizing patients with repeated burn injuries at a large tertiary referral burn center in the United States.

Background: Psychiatric and substance use disorders are common among trauma and burn patients and are known risk factors for repeat episodes of trauma, known as trauma recidivism. The epidemiology of burn recidivism, specifically, has not been described. This study aimed to characterize cases of burn recidivism at a large US tertiary care burn center and compare burn recidivists (RCs) with non-recidivists (NRCs).

Acute Pharmacological Management of Behavioral and Emotional Dysregulation Following a Traumatic Brain Injury: A Systematic Review of the Literature.

Background: Traumatic brain injury (TBI) is an increasingly common cause of behavioral and emotional dysregulation among hospitalized patients. While consultation-liaison psychiatrists are often called to help manage these behaviors, acute pharmacological management guidelines are limited.

Objective: Conduct a systematic review to determine which pharmacological measures are supported by the literature for targeting agitation and aggression in the acute time period following a TBI.

Catatonia After Liver Transplantation.

BACKGROUND Central nervous system complications after transplantation occur in up to 40% of recipients and these complications are associated with increased length of hospital stay and mortality. Catatonia is a neuropsychiatric clinical syndrome which has been described in case reports and in a small case series as occurring in the immediate post-solid organ transplantation (SOT) period, and it has been attributed to calcineurin inhibitor neurotoxicity, psychological vulnerability, and depression. Among transplant recipients, the incidence of catatonia is unknown; it may be under diagnosed in part due to a broad differential diagnosis in the post-transplantation setting, which includes hypoactive delirium, non-convulsive status epilepticus, drug toxicity, conversion disorder, and volitional uncooperativeness.

A Retrospective Analysis of Neurocognitive Impairment in Older Patients With Burn Injuries.

Background: Older adults comprise a growing proportion of the United States population that is at risk for burns. However, few studies have examined cognitive function in this patient population.

Objective: The purpose of this study was to measure the prevalence and incidence of dementia and delirium in older adults admitted for burn injuries.

Risk factors differ between recurrent and incident preeclampsia: a hospital-based cohort study.

Purpose: To examine whether risk factors, including prepregnancy body mass index (BMI), differ between recurrent and incident preeclampsia.

Methods: Data included electronic medical records of nulliparas (n = 26,613) delivering 2 times or more in Utah (2002-2010). Modified Poisson regression models were used to examine (1) adjusted relative risks (RR) of preeclampsia and 95% confidence intervals (CI) associated with prepregnancy BMI; (2) maternal risk factor differences between incident and recurrent preeclampsia among primiparous women.

Controlled direct effects of preeclampsia on neonatal health after accounting for mediation by preterm birth.

Background: Preeclampsia is characterized by alterations in angiogenic factors that may increase neonatal morbidity independent of preterm birth.

Methods: We estimated the controlled direct effect of preeclampsia on neonatal outcomes independent of preterm birth among 200,103 normotensive and 10,507 preeclamptic singleton pregnancies in the Consortium on Safe Labor (2002-2008). Marginal structural models with stabilized inverse probability weights accounted for potential confounders in the pathway from preeclampsia to preterm birth to neonatal outcomes, including mediator-outcome confounders related to preeclampsia status, such as cesarean delivery.

Racial/ethnic differences in pregnancy-related hypertensive disease in nulliparous women.

Objective: Hypertension and cardiovascular disease rates vary by race/ethnicity in nonpregnant adults. We aimed to examine racial/ethnic differences in prevalence and severity of hypertensive diseases during pregnancy in nulliparous women.

Design, Setting, Participants: Nulliparous women with singleton deliveries and electronic medical record data on demographics and pregnancy outcomes (n = 56,617) were selected from the Consortium on Safe Labor (2002-2008).

First trimester coffee and tea intake and risk of gestational diabetes mellitus: a study within a national birth cohort.

Objective: Coffee and tea consumption is associated with a decreased type 2 diabetes risk in non-pregnant adults. We examined the relation between first trimester coffee and tea consumption and gestational diabetes mellitus (GDM) risk.

Design: Population-based cohort study.

Neonatal and maternal outcomes with prolonged second stage of labor.

Objective: To assess neonatal and maternal outcomes when the second stage of labor was prolonged according to American College of Obstetricians and Gynecologists guidelines.

Methods: Electronic medical record data from a retrospective cohort (2002-2008) from 12 U.S.

Acute air pollution exposure and blood pressure at delivery among women with and without hypertension.

Background: Chronic air pollution exposure increases risk for hypertensive disorders of pregnancy, but the effect of acute air pollution exposure on blood pressure during pregnancy is less well known.

Methods: We studied 151,276 singleton term deliveries from the Consortium on Safe Labor (2002-2008) with clinical blood pressure measured at admission to labor/delivery and diagnoses of hypertensive disorders collected from electronic medical records and hospital discharge summaries. Air pollution exposures were estimated for the admission hour and the 4 hours preceding admission using a modified version of the Community Multiscale Air Quality models and observed air monitoring data.

Differences in risk factors for incident and recurrent small-for-gestational-age birthweight: a hospital-based cohort study.

Objective: Examine whether small-for-gestational-age (SGA) risk factors differed by prior SGA birth.

Design: Hospital-based cohort study.

Setting: Utah, USA.

Neonatal outcomes in early term birth.

Objective: To determine neonatal morbidity rates for early term birth compared with full term birth by precursor leading to delivery.

Study Design: This was a retrospective study of 188,809 deliveries from 37 0/7 to 41 6/7 weeks of gestation with electronic medical record data from 2002 to 2008. Precursors for delivery were categorized as spontaneous labor, premature rupture of membranes indicated, and no recorded indication.

Maternal overweight and obesity and risk of congenital heart defects in offspring.

Objective: Obesity is a risk factor for congenital heart defects (CHDs), but whether risk is independent of abnormal glucose metabolism remains unknown. Data on whether overweight status increases the risk are also conflicting.

Research Design And Methods: We included 121 815 deliveries from a cohort study, the Consortium on Safe Labor (CSL), after excluding women with pregestational diabetes as recorded in the electronic medical record.

Changes in diabetes status between pregnancies and impact on subsequent newborn outcomes.

Objective: Pregnancies complicated by gestational diabetes mellitus (GDM) or preexisting diabetes mellitus (DM) are at high risk for adverse newborn outcomes. Whether GDM history, recurrence, or transition to DM modifies such risks is unknown.

Study Design: Medical record data on 62,013 repeat singleton pregnancies were collected retrospectively from women who delivered at least twice in Utah (2002 through 2010).

Maternal lipid change in relation to length of gestation: a prospective cohort study with preconception enrollment of women.

Background/aims: We sought to investigate the association between preconception serum lipids and their daily rate of change in relation to length of gestation.

Methods: In a cohort of 70 women, 61 (87%) became pregnant, resulting in 48 (69%) live births. Serum lipid measurements (in milligrams per deciliter) included total cholesterol, free cholesterol, triglycerides and phospholipids at preconception, upon human chorionic gonadotropin-confirmed pregnancy and following pregnancy loss (<14 weeks) or post partum.

The association between parity and birthweight in a longitudinal consecutive pregnancy cohort.

Background: Nulliparity is associated with lower birthweight, but few studies have examined how within-mother changes in risk factors impact this association.

Methods: We used longitudinal electronic medical record data from a hospital-based cohort of consecutive singleton live births from 2002-2010 in Utah. To reduce bias from unobserved pregnancies, primary analyses were limited to 9484 women who entered nulliparous from 2002-2004, with 23,380 pregnancies up to parity 3.