scholarly journals Effect of cannabis use on PTSD treatment outcomes in veterans

2021 ◽  
Vol 11 (4) ◽  
pp. 238-242
Author(s):  
Meagan Petersen ◽  
Katherine Koller ◽  
Craig Straley ◽  
Ellen Reed
Keyword(s):  
Medical Center ◽  
Treatment Success ◽  
White Male ◽  
Relative Number ◽  
Receptor Activation ◽  
Cannabis Use ◽  
Evidence Based ◽  
Cannabinoid Type 1 Receptor ◽  
Ptsd Treatment ◽  
Number Of Treatment

Abstract Introduction Researchers have found anandamide (an endocannabinoid) and cannabinoid type 1 receptor activation encourages extinction of aversive memories. Some theorize cannabinoids such as those in cannabis may provide a new treatment approach for PTSD, while others suggest it may worsen symptomology. The objective of the current study was to determine if cannabis use impacts the success of evidence-based intensive outpatient PTSD treatment in a veteran population. Methods A list of veterans enrolled in the Battle Creek Veterans' Affairs Medical Center outpatient PTSD Clinical Team Clinic between October 1st, 2008 and October 1st, 2016 was obtained, and a random sample was identified. Study participants were veterans aged 18 to 85 years, with at least 2 PTSD Checklist scores, and a diagnosis of PTSD. Data collected included mental health medications, type and number of evidence-based psychotherapy used, and presence of co-occurring behavioral health diagnoses. The cannabis use group was compared to the no-cannabis-use group, and differences in variables pertaining to the relative number of treatment successes and failures was evaluated for statistical and clinical significance. Results The majority of patients were white (87.1%) and male (95%). The success rate was similar between the cannabis and no-cannabis-use groups (51.9% and 51.4%, respectively). Discussion The current study did not show that a predominantly white male veteran sample diagnosed with PTSD differed in intensive PTSD treatment success or failure based on cannabis use.

American Academy of Otolaryngology–Head and Neck Surgery/Foundation Reg-ent Registry: Purpose, Properties, and Priorities

2021 ◽  
pp. 019459982098413
Author(s):  
Cecelia E. Schmalbach ◽  
Jean Brereton ◽  
Cathlin Bowman ◽  
James C. Denneny
Keyword(s):  
American Academy ◽  
Head And Neck ◽  
Best Practice ◽  
Medical Center ◽  
Quality Care ◽  
Academic Medical Center ◽  
Neck Surgery ◽  
Performance Measure ◽  
Head And Neck Surgery ◽  
Evidence Based

Objective (1) To describe the patient and membership cohort captured by the otolaryngology-based specialty-specific Reg-ent registry. (2) To outline the capabilities of the Reg-ent registry, including the process by which members can access evidence-based data to address knowledge gaps identified by the American Academy of Otolaryngology–Head and Neck Surgery/Foundation and ultimately define “quality” for our field of otolaryngology–head and neck surgery. Methods Data analytics was performed on Reg-ent (2015-2020) Results A total of 1629 participants from 239 practices were enrolled in Reg-ent, and 42 health care specialties were represented. Reg-ent encompassed 6,496,477 unique patients and 24,296,713 encounters/visits: the 45- to 64-year age group had the highest representation (n = 1,597,618, 28.1%); 3,867,835 (60.3%) patients identified as Caucasian; and “private” was the most common insurance (33%), followed by Blue Cross/Blue Shield (22%). Allergic rhinitis–unspecified and sensorineural hearing loss–bilateral were the top 2 diagnoses (9% each). Overall, 302 research gaps were identified from 17 clinical practice guidelines. Discussion Reg-ent benefits are vast—from monitoring one’s practice to defining otolaryngology–head and neck surgery quality, participating in advocacy, and conducting research. Reg-ent provides mechanisms for benchmarking, quality assessment, and performance measure development, with the objective of defining and guiding best practice in otolaryngology–head and neck surgery. To be successful, patient diversity must be achieved to include ethnicity and socioeconomic status. Increasing academic medical center membership will assist in achieving diversity so that the quality domain of equitable care is achieved. Implications for Practice Reg-ent provides the first ever registry that is specific to otolaryngology–head and neck surgery and compliant with HIPAA (Health Insurance Portability and Accountability Act) to collect patient outcomes and define evidence-based quality care.

scholarly journals Evaluating the Impact of Training Health Professionals to Deliver Brief Motivational and Skills-Based Interventions for Cannabis Use Disorder

2012 ◽  
Vol 2 ◽  
Author(s):  
Dion Alperstein ◽  
Jan Copeland
Keyword(s):  
Clinical Training ◽  
Health Workers ◽  
Clinical Skills ◽  
Cannabis Use ◽  
Evidence Based ◽  
Transfer Of Knowledge ◽  
Evidence Based Treatment ◽  
Cognitive Behavioural ◽  
The Impact

Background: While there is considerable evidence that brief motivational and skills-based interventions for substance use are effective, little is known regarding the transfer of knowledge from research to practice. This study aims to evaluate the effectiveness of two half-day didactic clinical training workshops for allied health workers, which did not incorporate feedback or supervision, via independent follow-up three months post training.Methods: In total, 1322 participants attended either or both of the evidence-based treatment workshops run by the National Cannabis Prevention and Information Centre. Of those participants, 495 (37%) completed an online follow-up evaluation three months later regarding their use of the newly learnt intervention(s).Results: At follow-up, 270 (54.5%) participants had an opportunity to use the skills and 144 (53.3%) of those participants reported having used the clinical skills taught in the workshop. Of those who used one of the interventions, 90 (62.5%) participants reported their clients had reduced or quit their cannabis use. Furthermore, 43 (30%) of these participants had attempted to train others in the workplace in the techniques learnt in the workshop.Conclusion: Even a half-day didactic clinical training workshop on evidence-based brief cognitive–behavioural techniques delivered to clinicians working in the field can improve knowledge and confidence among clinicians and outcomes among their clients with cannabis use related problems.

Fidelity with Flexibility

2016 ◽  
Author(s):  
Lisa Sanetti ◽  
Melissa A. Collier-Meek ◽  
Lindsay Fallon
Keyword(s):  
Treatment Success ◽  
Treatment Fidelity ◽  
Evidence Based ◽  
Client Outcomes ◽  
Cultural Fit ◽  
Therapeutic Outcomes ◽  
Client Factors ◽  
Evidence Based Treatments ◽  
Evidence Supported Treatments ◽  
The Relationship

Research has linked the use of evidence-supported treatments to effective, efficient therapeutic outcomes. Questions related to the best way to disseminate and implement evidence-supported treatments in the field has led to discussions about transportability of treatments from controlled to applied settings. Specifically, scholars have focused on issues related to treatment fidelity, acceptability, and adoption versus adaptation of evidence-based treatments in practice. Treatment fidelity, a multidimensional construct, pertains to how extensively a treatment is delivered to a client, and it may be affected by several variables. Although the relationship is complex, treatment fidelity is considered an important moderator of client outcomes. Furthermore, the acceptability of a treatment appears to be of importance. Simply, if a treatment is perceived to be acceptable, it is more likely to be implemented with high levels of fidelity, increasing the chances that successful therapeutic outcomes will result. Nevertheless data indicate that some clinicians are wary of using evidence-supported treatments; their chief concern is feasibility of implementation, which could affect treatment fidelity and acceptability. Thus, there is a debate about whether evidence-supported treatments should be adopted strictly as developed or whether they might be adapted to improve implementation and acceptability. In adaptation of a treatment, relevant clinician variables (e.g., training received, availability of resources) and client factors (e.g., cultural fit) might be considered to promote therapeutic outcomes. This chapter describes how the key to treatment success may be to strike a balance between fidelity and adaptation of evidence-based treatments and fidelity with flexibility.

Retrospective Review of Perioperative Multimodal Analgesia for Orthopedic Patients in a Veterans Affairs Setting

2021 ◽  
Vol 36 (8) ◽  
pp. 397-408
Author(s):  
Christine M. Vartan ◽  
Nayma Moya Romero ◽  
Sandra L. DiScala ◽  
Abigail Brooks ◽  
John Melendez-Benabe ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Enhanced Recovery ◽  
Medical Center ◽  
Multimodal Analgesia ◽  
Veterans Affairs ◽  
Internal Quality ◽  
Evidence Based ◽  
Quality Audit ◽  
Secondary Objective ◽  
Hip Arthroplasties

OBJECTIVES: To determine adherence of perioperative knee/hip arthroplasties and hip fracture repairs to the American Pain Society (APS) guideline recommendations for perioperative pain control. One secondary objective was to perform an internal quality audit on the use of enhanced recovery after surgery (ERAS) protocols; another secondary objective was to design an evidence-based, multi-modal perioperative quick-order menu (if warranted). DESIGN/PATIENTS: A retrospective quality improvement (QI) review of uncomplicated knee/hip replacement and hip fracture repairs from January 2018 through March 2018. SETTING: West Palm Beach Veterans Affairs Medical Center (WPB VAMC) including acute care, subacute rehabilitation, and outpatient setting. MAIN OUTCOME MEASURE: Analgesic use in the perioperative setting via electronic health record review. RESULTS: Forty-seven patients were retrospectively reviewed. Perioperative multi-modal analgesia was used in 85% of patients. Eighty-seven percent were discharged on multi-modal analgesia. There was a 67% response rate to the internal quality audit on ERAS protocol usage from the orthopedic team. CONCLUSION: A retrospective QI review completed approximately two years after APS guideline publication showed that compliance with these recommendations for multi-modal analgesia (consisting of the use of at least two medication classes) at the WPB VAMC in the postoperative setting for knee/hip arthroplasties and hip fracture repairs was 85%. This indicated potential for improvement in achieving a pharmacologic multimodal and ERAS intervention. The authors developed an evidence-based quick-order menu to further reinforce adherence to the APS perioperative guidelines.

Operationalizing the Science

2011 ◽  
pp. 1600-1622
Author(s):  
Joseph L. Kannry
Keyword(s):  
United States ◽  
Medical Informatics ◽  
21St Century ◽  
Medical Center ◽  
The United States ◽  
Clinical Informatics ◽  
Evidence Based ◽  
Medical Practices ◽  
Healthcare It ◽  
Compare And Contrast

Healthcare IT (HIT) has failed to live up to its promise in the United States. HIT solutions and decisions need to be evidence based and standardized. Interventional informatics is ideally positioned to provide evidence based and standardized solutions in the enterprise (aka, the medical center) which includes all or some combination of hospital(s), hospital based-practices, enterprise owned offsite medical practices, faculty practice and a medical school. For purposes of this chapter, interventional informatics is defined as applied medical or clinical informatics with an emphasis on an active interventional role in the enterprise. A department of interventional informatics, which integrates the science of informatics into daily operations, should become a standard part of any 21st century medical center in the United States. The objectives of this chapter are to: review and summarize the promise and challenge of IT in healthcare; define healthcare IT; review the legacy of IT in healthcare; compare and contrast IT in healthcare with that of other industries; become familiar with evidence based IT: Medical informatics; differentiate medical informatics from IT in healthcare; distinguish medical, clinical, and interventional informatics; justify the need for operational departments of interventional informatics.

scholarly journals Chronic lymphocytic leukemia (CLL) terminating in multiple myeloma: report of two cases

Blood ◽  
1978 ◽  
Vol 52 (3) ◽  
pp. 532-536 ◽  
Author(s):  
RH Kough ◽  
AZ Makary
Keyword(s):  
Multiple Myeloma ◽  
Bone Marrow ◽  
Chronic Lymphocytic Leukemia ◽  
Plasma Cells ◽  
Medical Center ◽  
White Male ◽  
Lymphocytic Leukemia ◽  
Light Chains ◽  
White Female ◽  
Pathologic Fractures

Abstract Two cases of multiple myeloma (MM) developed late in the course of chronic lymphocytic leukemia (CLL). An 81-yr-old white female developed, after 6 yr of CLL, IgAk MM with sheets of plasma cells abutting sheets of lymphocytes in the bone marrow, multiple pathologic fractures, and 0.26 g/24 free k light chains in the urine. A 74-yr-old white male developed, after 16 yr of CLL, k light chain MM with 20% plasma cells in the bone marrow, multiple panthologic fractures, and 3.7 g/24 hr free k light chains in the urine. In both cases the CLL had responded well to intermittent low-dose chlorambucil therapy, but the MM failed to respond to cyclic melphalanprednisone therapy. A review of 105 cases of CLL seen at the Geisinger Medical Center failed to turn up any other cases of MM developing during the course of CLL. The suggestion that there is an increased prevalence of MM in CLL is an attractive one because both diseases are B cell neoplasms and because of the increased frequency of asymptomatic monoclonal gammopathies in CLL found by others.

Operationalizing the Science

2011 ◽  
pp. 219-239
Author(s):  
Joseph L. Kannry
Keyword(s):  
United States ◽  
Medical Informatics ◽  
21St Century ◽  
Medical Center ◽  
The United States ◽  
Clinical Informatics ◽  
Evidence Based ◽  
Medical Practices ◽  
Healthcare It ◽  
Compare And Contrast

Healthcare IT (HIT) has failed to live up to its promise in the United States. HIT solutions and decisions need to be evidence based and standardized. Interventional informatics is ideally positioned to provide evidence based and standardized solutions in the enterprise (aka, the medical center) which includes all or some combination of hospital(s), hospital based-practices, enterprise owned offsite medical practices, faculty practice and a medical school. For purposes of this chapter, interventional informatics is defined as applied medical or clinical informatics with an emphasis on an active interventional role in the enterprise. A department of interventional informatics, which integrates the science of informatics into daily operations, should become a standard part of any 21st century medical center in the United States. The objectives of this chapter are to: review and summarize the promise and challenge of IT in healthcare; define healthcare IT; review the legacy of IT in healthcare; compare and contrast IT in healthcare with that of other industries; become familiar with evidence based IT: Medical informatics; differentiate medical informatics from IT in healthcare; distinguish medical, clinical, and interventional informatics; justify the need for operational departments of interventional informatics.

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