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1.
Am J Transplant ; 22(10): 2302-2305, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-35510751

RESUMO

Donation after circulatory determination of death (DCDD) has increased organ donation rates in the US over the past decade within an established legal framework, which is consistent with and supports individual and family decisions regarding organ donation in the context of end-of-life care. A new application, controlled DCDD donation utilizing thoracoabdominal normothermic regional perfusion (NRP) protocols (cDCDD-NRP), provides the opportunity to maximize a donation decision by recovering additional organs for transplant, including the heart, and to limit the detrimental impact of warm ischemic time by perfusing organs in situ following the declaration of circulatory death. In this viewpoint, we narrate our rationale for why cDCDD-NRP is consistent within the existing legal framework for organ donation in the United States and recommend no changes to the Uniform Determination of Death Act.


Assuntos
Preservação de Órgãos , Obtenção de Tecidos e Órgãos , Morte , Humanos , Preservação de Órgãos/métodos , Perfusão/métodos , Doadores de Tecidos , Estados Unidos
2.
Psychol Trauma ; 13(6): 632-640, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32915044

RESUMO

OBJECTIVE: While the comparative efficacy of prolonged exposure (PE) and cognitive processing therapy (CPT) has been examined in outpatient settings, there is a dearth of literature on the relative effectiveness of these interventions when adapted for an intensive treatment format. In an expanded secondary analysis of a previous study, we sought to examine the comparative effectiveness of PE and CPT delivered in the naturalistic setting of an intensive treatment format including maintenance of outcomes through a 6-month follow-up period. METHOD: A sample of 296 veterans with posttraumatic stress disorder (PTSD) received either PE (n = 186) or CPT (n = 90), alongside other trauma-informed interventions, in a 2-week intensive clinical program. Treatment selection was determined collaboratively between patient and therapist. Our primary outcome was self-reported PTSD symptom severity (i.e., PTSD Checklist for DSM-5, PCL-5); secondarily, we examined self-reported depression (i.e., Patient Health Questionnaire) symptom severity outcomes. RESULTS: A mixed-model regression controlling for age and gender revealed a significant effect of time from baseline to endpoint (p < .001), 3-month (p < .001), and 6-month follow-up (p < .001) on PCL-5 scores but no significant effect of treatment or effect of treatment by time interaction (all ps > .05; model: Wald's χ² = 232.38, p < .001). Results were similar for depression outcomes. Attrition at posttreatment was not significantly different between groups: 7.2% for CPT and 6.5% PE (z score = 0.22). CONCLUSIONS: Both PE and CPT are associated with comparable improvements when delivered as part of a 2-week intensive outpatient program. (PsycInfo Database Record (c) 2022 APA, all rights reserved).


Assuntos
Terapia Cognitivo-Comportamental , Militares , Transtornos de Estresse Pós-Traumáticos , Veteranos , Terapia Cognitivo-Comportamental/métodos , Manual Diagnóstico e Estatístico de Transtornos Mentais , Humanos , Processos Mentais , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos de Estresse Pós-Traumáticos/terapia , Veteranos/psicologia
4.
Issues Ment Health Nurs ; 39(10): 850-857, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30212258

RESUMO

There are over one million post-9/11 military caregivers in the United States who face a variety of stressors inherent to caring for an incapacitated loved one. Mind-body interventions, such as the Stress Management and Resilience Training Relaxation Response Resiliency Program (SMART-3RP), have been shown to reduce stress and improve overall health and functioning. The present qualitative study aims to explore stressors experienced by military caregivers in their caregiving role and to assess attitudes towards the virtual delivery of the SMART-3RP. We conducted two focus groups with a total of 13 caregivers [M (SD) age = 41.25 (11.49); 92% female], and participants subsequently completed a survey on their caregiving experiences. Focus groups were conducted remotely via Google Hangouts by two doctoral-level clinicians, transcribed verbatim, and coded using inductive thematic analysis. Themes related to stressors of caregiving included: logistical stressors faced by caregivers, demands of the caregiving role, concerns about children, worries about the future, exacerbation of the caregiver's physical/mental health concerns, social dynamics, sacrifices made for their veteran in the caregiving role, and relationship dynamics between the veteran and caregiver. Military caregivers found the SMART-3RP logical and felt as though it could be helpful to them. Caregivers expressed interest in a brief, virtual version of the SMART-3RP. Using the findings from the current study, we are adapting the SMART-3RP to be administered virtually as a podcast-based intervention.


Assuntos
Cuidadores/psicologia , Militares/psicologia , Terapias Mente-Corpo , Apoio Social , Estresse Psicológico/prevenção & controle , Veteranos/psicologia , Adulto , Emoções , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Estresse Psicológico/diagnóstico , Estresse Psicológico/etiologia , Inquéritos e Questionários , Estados Unidos
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