Factors contributing to veterans' satisfaction with PTSD treatment delivered in person compared to telehealth.

INTRODUCTION: Telehealth is an increasingly popular treatment delivery modality for mental healthcare, including evidence-based treatment for complex and intense psychopathologies such as post-traumatic stress disorder (PTSD). Despite the growing telehealth literature, there is a need for more confirmatory research on satisfaction with PTSD telehealth treatment, particularly among veterans, for whom the most rapid and permanent expansion of telehealth services has been implemented through the Department of Veterans Affairs. METHODS: The current paper integrates data from two concurrent PTSD treatment outcome studies that compared prolonged exposure therapy delivered both in person and via telehealth for veterans (N = 140). Using two different measures of satisfaction (the Charleston Psychiatric Outpatient Satisfaction Scale-Veteran Affairs Version (CPOSS) and the Service Delivery Perception Questionnaire (SDPQ)), we hypothesized that PTSD improvement would predict satisfaction, but that delivery modality (in person vs telehealth) would not. RESULTS: Results only partially supported the hypotheses, in that PTSD symptom improvement was associated with greater satisfaction, and in-person treatment modality was associated with satisfaction as measured by the CPOSS (but not the SDPQ). Subgroup differences by sex were found, such that male veterans, typically with combat-related trauma, were more satisfied with their PTSD treatment compared to female veterans, who were most frequently seen in this study for military sexual trauma. DISCUSSION: Altogether, results illustrate a need for additional satisfaction studies with diverse samples and large sample sizes. Future research may benefit from examining satisfaction throughout treatment, identifying predictors of greater PTSD improvement, and further examining demographic subgroups.

Integrating trauma-informed care into clinical practice with trafficked persons.

Trauma-informed care (TIC) as practiced within anti-human trafficking work is still in its early stages, and there is a significant need for specific guidelines concerning how to apply TIC principles along various phases of behavioral health care. Thus, the goals of this article are to (1) provide an overview of the framework of TIC; (2) identify and summarize the literature that specifically highlights the clinical application of TIC principles; and (3) contribute to the existing literature by providing some examples of integrating TIC principles into patient-clinician interactions with trafficked patients. The authors' hope is that mental health providers will reference the provided script examples to help improve patient-provider interactions and to develop better rapport and trust between providers and trafficked persons.

Assessment of BNP and NT-proBNP in emergency department patients presenting with suspected acute coronary syndromes.

OBJECTIVES: The relationship between BNP and NT-proBNP among physiologically and clinically relevant demographic subgroups has never been clarified in the context of the emergency department (ED). DESIGN AND METHODS: A blood sample taken from patients presenting to the E.D. with suspected acute coronary syndromes (ACS) was analyzed for BNP and NT-proBNP, and correlation between them was examined as an entire group then as subgroups according to gender, ethnicity, age, and comorbidity variables. RESULTS: BNP and NT-proBNP correlate well (0.89, P < 0.0001) in a population of 420 patients and in patient subgroups with a history of various etiologies, including vascular disorders. CONCLUSIONS: In general, BNP and NT-proBNP correlate very well in patients with suspected ACS and may aid in the risk stratification process in emergency departments.

Independent validation of candidate breast cancer serum biomarkers identified by mass spectrometry.

BACKGROUND: We previously selected a panel of 3 breast cancer biomarkers (BC1, BC2, and BC3) from serum samples collected at a single hospital based on their collective contribution to the optimal separation of breast cancer patients and noncancer controls by surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF MS). The identities and general applicability of these markers, however, were unknown. In this study, we performed protein expression profiling on samples obtained from a second hospital, included a greater number of ductal carcinoma in situ (DCIS) cases, and performed purification and identification of the 2 confirmed markers. METHODS: Using a case-control study design, we performed protein expression profiling on serum samples from the National Cancer Institute (Milan, Italy). The validation sample cohort consisted of 61 women with locally invasive breast cancer, 32 with DCIS, 37 with various benign breast diseases (including 13 atypical), and 46 age-matched apparently healthy women (age range, 44-68 years). Validated biomarkers were purified and identified with serial chromatography, 1-dimensional gel electrophoresis, in-gel ASP-N digestion, peptide mass fingerprinting, and tandem mass peptide sequencing. RESULTS: The BC3 and BC2 expression patterns in this sample set were consistent with the first study sample set. BC3 and BC2 were identified to be complement component C3a(desArg) and a C-terminal-truncated form of C3a(desArg), respectively. CONCLUSIONS: Evaluation of biomarkers in independent sample sets can help determine the broader utility of candidate markers, and protein identification permits understanding of their molecular basis. C3a(desArg) appears to lack specificity among patients with benign diseases, limiting its utility as a stand-alone tumor marker, but it may still be useful in a multimarker panel for early detection of breast cancer.

Bioinformatics strategies for proteomic profiling.

Clinical proteomics is an emerging field that involves the analysis of protein expression profiles of clinical samples for de novo discovery of disease-associated biomarkers and for gaining insight into the biology of disease processes. Mass spectrometry represents an important set of technologies for protein expression measurement. Among them, surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI TOF-MS), because of its high throughput and on-chip sample processing capability, has become a popular tool for clinical proteomics. Bioinformatics plays a critical role in the analysis of SELDI data, and therefore, it is important to understand the issues associated with the analysis of clinical proteomic data. In this review, we discuss such issues and the bioinformatics strategies used for proteomic profiling.