scholarly journals Evaluation of a Sudarshan Kriya Yoga (SKY) based breath intervention for patients with mild-to-moderate depression and anxiety disorders*

2019 ◽  
Vol 20 ◽  
Author(s):  
Kate Hamilton-West ◽  
Tracy Pellatt-Higgins ◽  
Farnaaz Sharief
Keyword(s):  
Anxiety Disorders ◽  
Therapeutic Option ◽  
Cost Savings ◽  
Routine Care ◽  
Depression And Anxiety ◽  
Potential Cost ◽  
Breathing Exercises ◽  
Moderate Depression ◽  
Uk National Health Service

Abstract Aim Research identifies a need for expanded therapeutic options for people with mild-to-moderate depression and anxiety disorders treated within the UK National Health Service (NHS). We aimed to examine potential benefits of a Sudarshan Kriya Yoga (SKY) based breath intervention delivered in this context. Background SKY is a structured programme derived from yoga in which participants are taught relaxation and stress-management techniques including body postures, breathing exercises and cognitive-behavioural procedures. Previous research has demonstrated benefits for patients with clinical and non-clinical depression and anxiety. However, SKY has not yet been evaluated as a therapeutic option for patients accessing NHS primary care mental health services. Methods We evaluated an existing programme available to NHS patients in South East England. The intervention is community-based and delivered via four weekly ‘stress buster sessions’ (1-h duration), one weekend intensive workshop (2.5 days) and four weekly (90 min) follow-up sessions. Analyses were conducted on existing data [measures of depression (Patient Health Questionnaire-9) and anxiety (generalised anxiety disorder-7)] collected as part of routine care, at the start of the programme and three follow-up assessments. Findings Baseline data were available for 991 participants, of which 557 (56.2%) attended at least three weekly workshops, 216 (21.8%) attended the weekend workshop and 169 (17.1%) completed the programme. Statistically significant (P<0.05) improvements in depression and anxiety were observed in all three outcome assessments. Clinically meaningful change was observed for 74.6% of participants completing the programme. Findings indicate that SKY has the potential to benefit patient outcomes and could be offered more widely as a therapeutic option. We recommend further research to explore patients’ experiences of the programme, determine the number of sessions necessary for improvement/ recovery, define the population most likely to respond and examine potential cost savings (e.g., reductions in antidepressant prescribing/referrals to secondary care).

scholarly journals Predictive value of implicit and explicit self-esteem for the recurrence of depression and anxiety disorders: A 3-year follow-up study.

2020 ◽  
Vol 129 (8) ◽  
pp. 788-798
Author(s):  
Lonneke A. van Tuijl ◽  
Elise C. Bennik ◽  
Brenda W. J. H. Penninx ◽  
Philip Spinhoven ◽  
Peter J. de Jong
Keyword(s):  
Anxiety Disorders ◽  
Predictive Value ◽  
Self Esteem ◽  
Depression And Anxiety ◽  
Follow Up Study ◽  
Implicit And Explicit

Prodromes of Depression and Anxiety

1989 ◽  
Vol 155 (4) ◽  
pp. 490-495 ◽  
Author(s):  
Jane M. Murphy ◽  
Arthur M. Sobol ◽  
Donald C. Olivier ◽  
Richard R. Monson ◽  
Alexander H. Leighton ◽  
...  
Keyword(s):  
General Population ◽  
Anxiety Disorders ◽  
Psychiatric Epidemiology ◽  
Depression And Anxiety ◽  
Longitudinal Investigation ◽  
Incident Cases ◽  
Premonitory Symptoms

A longitudinal investigation of psychiatric epidemiology in a general population (the Stirling County study) has indicated that the incidence of depression and anxiety disorders is low relative to prevalence, because these disorders have long durations. In an average year approximately nine adults among 1000 experience a first-ever episode of one of these disorders. Incident cases over the course of a 16-year follow-up were more likely to have had premonitory symptoms than to have been asymptomatic at the beginning of the study. Among the relatively small number of people who exhibited the clearest prodromal manifestations, incidence was 20 per 1000 annually. It might be possible to intervene before such disorders become fully formed and persistent if the precursors are given attention.

Implementation of antipsychotic selection recommendations at a veterans affairs facility

2013 ◽  
Vol 3 (4) ◽  
pp. 188-192 ◽  
Author(s):  
Jeff Clark ◽  
Jeff Gold ◽  
Sherri Hawk
Keyword(s):  
Blood Pressure ◽  
Second Generation ◽  
Fasting Glucose ◽  
Cost Savings ◽  
Veterans Affairs ◽  
Lipid Profiles ◽  
Second Line ◽  
First Line ◽  
Potential Cost

Introduction: In 2012, the Veterans Affairs (VA) Pharmacy Benefits Management Services created recommendations for antipsychotic selection in schizophrenia and schizoaffective disorders. The recommendations stated that patients must fail two first line agents (haloperidol, loxapine, quetiapine, risperidone or perphenazine) and clozapine (if appropriate) before being allowed to trial second line agents olanzapine, ziprasidone or aripiprazole. The aim of this project was to determine the amount of cost savings that could have been provided had the above recommendations been implemented last year. Use of second generation antipsychotics has been associated with weight gain, diabetes, and worsening lipid profiles. The American Diabetes Association (ADA) has created guidelines regarding cardiometabolic monitoring of second generation antipsychotic agents. A secondary aim of this project was to determine the rate of provider adherence to the ADA recommendations. Methods: A retrospective chart review was performed for patients &gt;18 years of age who were initiated on aripiprazole, ziprasidone, or olanzapine for all indications between July 1, 2011 and July 1, 2012. The costs of the mean doses of these agents were compared to an equivalent mean dose of the first line agent risperidone (4mg) using VA drug acquisition costs. Cardiometabolic monitoring data were collected to include weight, blood pressure, fasting glucose and fasting lipid profiles at baseline and at 12 weeks. Results: Of the 542 patients started on second line agents, only 68 met criteria for their use. A potential cost savings of over $850,000 may have been realized had these criteria been enacted within the one year time period studied. None of the 542 patients had both baseline and follow-up values for weight, blood pressure, fasting glucose and fasting lipid profiles. While roughly 60% of patients had blood pressure and weight values at baseline and 27% had glucose and cholesterol values, less than 14% received follow-up testing with approximately 2% receiving neither baseline nor follow-up testing. Discussion: Significant cost savings can be realized via the use of selection criteria without sacrificing efficacy as most studies do not demonstrate the superiority of one agent and the rates of adverse events between first and second generation agents are more similar than previously thought. This study also highlighted the lack of adequate cardiometabolic monitoring which could lead to cardiovascular disease.

231Local impedance-guided ablation and ultra-high density mapping provide improved ablation metrics vs conventional or contact force-guided ablation for cavotricuspid isthmus dependent atrial flutter

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
K Saraf ◽  
G M Morris
Keyword(s):  
Atrial Flutter ◽  
Contact Force ◽  
Cost Savings ◽  
High Density ◽  
Patient Specific ◽  
Procedure Time ◽  
Potential Cost ◽  
Cavotricuspid Isthmus ◽  
Density Mapping

Abstract INTRODUCTION. Radiofrequency ablation (RFA) of cavotricuspid isthmus dependent atrial flutter (CTI-AFL) can be performed with fluoroscopy (Fluo) or 3-dimensional (3D) electroanatomic mapping and contact force (CF) catheters. Local impedance (LI) is an alternative but no comparisons have yet been made. METHODS. An observational study comparing Fluo, CF- and LI-guided RFA for CTI-AFL. In the LI group, if CTI block was not obtained after initial ablation, ultra-high density mapping (UHDm) was used to identify breakthrough sites. Contact was determined using patient specific LI; RF delivered until 20 ohm LI drop seen, or LI drop plateaued &gt;2 secs. In the CF group 10-40g force was used. Power was limited to 40-50W in all groups. Total RFA time, time from RFA start to CTI block, no. of lesions required to achieve block, acute success, complications and re-ablation during follow-up were analysed using ANOVA. RESULTS. Data presented for 24 patients (7 Fluo, 7 CF, 10 LI). Mean RFA time: 6.6, 5.9, 3.2 min respectively (p = 0.0478). Statistically significant differences also seen with LI vs Fluo (p = 0.0451) and LI vs CF (p = 0.0313). Time from first RFA to block: 25.5, 19.8, 14.2 min (p = 0.5688); number of lesions to achieve block: 8.5, 10.3, 8 (p = 0.3909). 100% success and no complications in all groups. 0% need for re-ablation (16.3 ± 7, 12.6 ± 8, 6.5 ± 4.4 months follow-up). DISCUSSION. This data illustrates that UHDm and LI-guidance significantly reduces the amount of CTI RFA, by 52% and 47% vs Fluo and CF respectively (p = sig, fig. 1). A reduction from first RFA to block is also seen (43% and 37%; p = ns, fig. 2). Given no difference in the no. of lesions, LI-guided RFA during lesion formation shortens the duration of each lesion. Many patients require further RFA (+/- mapping) if they do not achieve block following the initial ablation line, resulting in longer procedures. Several patients without block in the LI group underwent repeat UHDm, which quickly identified CTI or epicardial-endocardial breakthrough (fig. 3 & 4), allowing rapid targeting for re-ablation. In the fluo group, these procedures would often be significantly prolonged, meaning extensive RFA and radiation exposure. Fig. 1 shows smaller error bars with LI compared to the others, resulting in more predictable total ablation times; this could potentially benefit procedure scheduling (more procedures per unit time). We could not directly compare overall procedure time as many in the CF group had CTI RFA combined with left atrial RFA. Multiple LI cases were performed fluo-free with only magnetic tracking. This may allow case scheduling without a radiographer, with potential cost savings. CONCLUSION. LI-guided CTI-AFL RFA is safe and effective and has shown favourable ablation metrics compared to Fluo or CF-RFA. LI-RFA with UHDm more quickly and accurately identifies breakthrough and with fluoro-free technique could possibly reduce procedure time and cost. A larger study is planned to provide more insight. Abstract Figures

scholarly journals Development of an Interprofessional Pharmacist-Nurse Navigation Pediatric Discharge Program

2018 ◽  
Vol 23 (4) ◽  
pp. 320-328
Author(s):  
Vy Nguyen ◽  
Danielle Altares Sarik ◽  
Michael C. Dejos ◽  
Elora Hilmas
Keyword(s):  
Patient Navigation ◽  
Cost Savings ◽  
Day Length ◽  
Phone Call ◽  
Care Process ◽  
Discharge Process ◽  
Financial Benefit ◽  
Potential Cost ◽  
The Impact

OBJECTIVES Numerous challenges face clinically complex patients as they transition from hospital to home. The purpose of this project was to add pharmacy discharge services to an existing nurse-led discharge service (patient navigation program) to facilitate the transition of care process for clinically complex pediatric patients. METHODS For select patients referred to the service, a pharmacist resolved medication discrepancies, provided discharge counseling, and conducted follow-up telephone encounters on days 1, 7, and 14 post discharge. Patient demographics, admitting diagnosis, and number of discharge medications were recorded. The impact on patient outcomes was measured by the number and type of pharmacist interventions identified. Program utilization was measured by the number of referrals received, percentage of patients seen by a pharmacist, follow-up phone call completion rate, and pharmacist time required. Financial benefit gained from the program was estimated by translating each pharmaceutical intervention into potential cost savings. RESULTS There were 321 patient navigation referrals during the 5 months of pharmacist service. A pharmacist was able to provide discharge counseling for 56 discharges (17%). Patients who were provided pharmacy services had a median of 8 comorbidities, 10-day length of stay, and 4 discharge medications. Pharmacists identified 168 interventions, of which 93.5% were accepted or informational in nature. The most frequently identified interventions included clarification of drug order, assistance obtaining medication, and dose rounding. This program resulted in an estimated cost savings of $22,308 in the first 5 months. CONCLUSIONS A unique partnership between nurses and pharmacists facilitated the discharge process for clinically complex children.

Oral Appliances for OSA Treatment: Meeting the Quadruple Aim

2021 ◽  
Author(s):  
S Knowles ◽  
Matthew Dekow ◽  
Michele L Williamson
Keyword(s):  
Obstructive Sleep Apnea ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Cost Savings ◽  
Oral Appliance ◽  
Potential Cost ◽  
Oral Appliance Therapy ◽  
Quadruple Aim ◽  
Obstructive Sleep

ABSTRACT Introduction In order to better treat obstructive sleep apnea (OSA) in a more efficient and cost-effective way, a joint program between dental clinics and the sleep medicine clinic was piloted at Fort Hood, Texas. Obstructive sleep apnea negatively affects soldier readiness and deployability, leading to the need to establish a successful and proven workflow to treat these patients with oral appliance therapy (OAT). Materials and Methods We performed a retrospective review of a de-identified data set which included 288 patients from July 2016 to July 2020. Projected cost data were obtained from routinely collected sleep clinic positive airway pressure (PAP) data. Data were analyzed to determine treatment success and potential cost savings using OAT versus continuous positive airway pressure (CPAP). Patient workflow including successes and challenges with the program is summarized. Results About 85.5% of patients met criteria for successful control of their OSA using OAT as treatment. Five patients did not tolerate OAT and switched back to CPAP. A higher (less severe) O2 nadir on diagnostic polysomnography is moderately correlated with OAT success. Diagnostic Apnea–Hypopnea Index was inversely and weakly correlated with success. Two of the major challenges noted in the program were (1) loss of follow-up and (2) the length of time from oral appliance referral to fitting the oral appliance. If this program was successfully implemented at other Defense Health Agency (DHA) medical treatment facility (MTF) markets nationwide, a potential cost savings of over $500,000/year/MTF could be achieved. Conclusions Oral appliance therapy has the potential to increase both readiness and deployability for active duty soldiers. Using baseline O2 nadir can help predict success with OAT patients, determining which patients will benefit from this joint program between the dental and medical sleep clinics. Future studies can aim to establish an evidence-based pathway for clinic testing and follow-up. If this patient workflow is implemented properly, there can be significant cost savings army-wide. This all helps The United States Medical Command (MEDCOM) align with the DHA’s Quadruple Aim of increased readiness, better health, better care, and lower cost.

Affective and Anxiety Disorders in the Long-Term Follow-up of Anorexia Nervosa

1989 ◽  
Vol 18 (4) ◽  
pp. 357-364 ◽  
Author(s):  
Brenda B. Toner ◽  
Paul E. Garfinkel ◽  
David M. Garner
Keyword(s):  
Anorexia Nervosa ◽  
Eating Disorder ◽  
Anxiety Disorders ◽  
Diagnostic Interview ◽  
Depression And Anxiety ◽  
Asymptomatic Group ◽  
Psychiatric Interview ◽  
Long Term Follow Up

This study investigated the incidence and onset of affective and anxiety disorders in women who were diagnosed with anorexia nervosa five to fourteen years earlier. Based on the clinical outcome of anorexia nervosa, patients were classified as asymptomatic, improved or symptomatic. Affective and anxiety disorders were assessed by a structured psychiatric interview (Diagnostic Interview Schedule). Results indicated that affective and anxiety disorders developed frequently, regardless of outcome of anorexia nervosa. Major depression and anxiety disorders developed before the eating disorder in one-half and three-quarters of these cases respectively. The symptomatic group had a significantly higher incidence of anxiety disorders prior to the development of their eating disorder compared with the asymptomatic group.

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