Teaching therapeutic seizure criteria to psychiatrists.

OBJECTIVES: Following on from our previous work looking at the interrater reliability of assessing seizure adequacy for electroconvulsive therapy (ECT), we sought to examine whether a specific teaching module could improve the reliability of visual inspection of electroencephalography (EEG) recordings for specific features of seizure length, presence of polyspike, δ wave activity, and post-ictal suppression. METHODS: Twelve medical practitioners at varying levels of training and ECT experience rated 15 EEG traces after minimal training and a further set of 15 EEG traces after a more detailed training. Results were analyzed to examine the interrater reliability of the EEG features and the overall assignment of traces as meeting "old" (1995) or "new" (2005) Royal College of Psychiatrists criteria for therapeutic seizures compared with the agreed ratings of 2 experienced ECT practitioners ("standard ratings"). RESULTS: There was evidence for a specific training effect for the "old" criteria with an improvement in the interrater reliability (generalized κ, 0.590 vs 0.813) associated with a significantly better estimation of seizure length as assessed by comparison of the root mean square difference from the standard ratings (mean, 7.83 vs 4.49; P < 0.003). The interrater reliability for the new criteria did not improve (generalized κ, 0.599 vs 0.581) but was already at quite a good standard. Examination of individual features did demonstrate improvement in the rating of δ activity (generalized κ, 0.564 vs 0.655) and post-ictal suppression (generalized κ, 0.553 vs 0.611) after the training. When these 2 criteria were grouped together (δ suppression), interrater reliability was shown to be significantly improved after the training (generalized κ, 0.568 vs 0.659). Although not statistically significant, the participants reported that the training improved their confidence in using both criteria for therapeutic seizures (old: 49% vs 67%; new: 27% vs 48%). CONCLUSIONS: The reliability of assessments of seizure length, presence of δ activity, and post-ictal suppression can be measurably improved with a specific teaching module. Using the δ suppression criteria together with the accurate estimation of seizure length on EEG may have greater clinical utility when it comes to instructing trainees in ECT administration, assessment of therapeutic seizures, and developing protocols for dose adjustment.

Review of Connections in the clinic: Relational narratives from team-based primary care.

Reviews the book, Connections in the Clinic: Relational Narratives from Team-Based Primary Care edited by Randall Reitz, Laura E. Sudano, and Mark P. Knudson (2021). This book is an edited collection of poems and stories reflecting the personal nature of the mission, vision, and practice of integrated primary care. This collection reflects the biopsychosocial model, which has been growing steadily in research and practice over the last few decades. These stories from the frontlines illustrate the increased awareness of the strong mind-body-interpersonal and team connections that are a critical part of a successful primary care system. This book is intended to be inspirational for anyone working in a primary care clinic. The editors describe the central purpose of the book is to find meaning in the relationships that are created in team-based primary care. This is a book where these stories are collected to expand our recognition and appreciation of the full diversity of patterns in our personal and work lives. The collection of stories is intended to inspire readers to actively practice their own reflections and learnings and encourages sharing them with others. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Interrater reliability of 2 definitions of seizure adequacy in electroconvulsive therapy.

OBJECTIVES: Clear evidence of a generalized seizure is regarded as an essential component of a therapeutic electroconvulsive therapy (ECT) session. Recent criteria, in particular, the Royal College of Psychiatry ECT Handbook (2005), suggest that the pattern of electroencephalographic (EEG) seizure is more important than the duration of the seizure when assessing seizure adequacy. We examined the reliability of using EEG criteria compared to simple measures of seizure duration by reviewing 100 sample EEG printouts obtained during ECT sessions in a Scottish hospital ECT unit. METHODS: The EEGs were independently assessed by 3 clinicians (a "control" ECT consultant, an experienced ECT therapist, and a less experienced trainee) blind to each other's ratings. RESULTS: While there was good interrater reliability for measures of seizure duration, kappa scores for EEG criteria were much better for the more than the less experienced rater (κ = 0.68 vs 0.50). Even greater differences were seen for individual components: polyspike activity (κ = 0.80 vs 0.55), spike and wave complexes (κ = 0.80 vs 0.38), and postictal suppression (κ = 0.63 vs 0.35). CONCLUSIONS: The implications of these finding are briefly discussed in the context of developing rational criteria for assessing ECT efficacy that rely upon the consistent and replicable delivery of standardized ECT techniques and consequent training needs of ECT practitioners.

An oncolytic virus-delivered TGFß inhibitor overcomes the immunosuppressive tumor microenvironment.

While checkpoint blockade immunotherapies have widespread success, they rely on a responsive immune infiltrate; as such, treatments enhancing immune infiltration and preventing immunosuppression are of critical need. We previously generated αPD-1 resistant variants of the murine HNSCC model MEER. While entirely αPD-1 resistant, these tumors regress after single dose of oncolytic vaccinia virus (VV). We then generated a VV-resistant MEER line to dissect the immunologic features of sensitive and resistant tumors. While treatment of both tumor types induced immune infiltration and IFNγ, we found a defining feature of resistance was elevation of immunosuppressive cytokines like TGFß, which blunted IFNγ signaling, especially in regulatory T cells. We engineered VV to express a genetically encoded TGFßRII inhibitor. Inhibitor-expressing VV produced regressions in resistant tumor models and showed impressive synergy with checkpoint blockade. Importantly, tumor-specific, viral delivery of TGFß inhibition had no toxicities associated with systemic TGFß/TGFßR inhibition. Our data suggest that aside from stimulating immune infiltration, oncolytic viruses are attractive means to deliver agents to limit immunosuppression in cancer.

Primary care mental health: a new frontier for psychology.

The medical system in this country is divided into primary care and specialty care. Mental health is for the most part a specialty service dependent on referrals, often from primary care providers. The authors propose a new model where psychologists work in collaboration with primary care medical teams. This integrated, coordinated model enables psychologists to help patients they would not otherwise see in a mental health system. Examples of patients in this category are seniors, those with somatizing disorders, and those experiencing the challenges of dealing with a chronic illness. This model also enables psychologists to provide consultation to the medical teams. In this article, the authors discuss the world of the primary care medical team and present the rationale for integration or collaboration. They describe the barriers to collaborative practices and ways to overcome these barriers. Finally, they present practical strategies that psychologists can use on a regular basis to increase their collaboration with primary care. These strategies can be used by those who work in colocated practices as well as those who work in separate locations.

Understanding social support and the couple's relationship among women with depressive symptoms in pregnancy.

This qualitative study explored the experiences of seven couples where the female partner experienced depressive symptoms during pregnancy. Female and male partners were interviewed together and data was collected and analyzed according to Colaizzi's ( 1978 ) phenomenological research design. The interviews yielded the following themes: (a) Challenges and stressors associated with depressive symptoms during pregnancy, (b) Pregnancy's effect on mood states, (c) Relationship dynamics that influence moods, (d) Pregnancy and the influence of mood on relationship dynamics, and (e) Reliance on external sources of support. The findings extend current research and provide insight into possibilities of how to enhance assessment and intervention for women who are depressed during pregnancy by including a relational component. Findings, clinical implications, and future research are discussed.

Reflections on clinician barriers to sexual health conversations: The need for education and encouragement.

Comments on the original article by M. R. Canzona et al. (see record 2018-12809-003) on the topic of initiating sexual health conversations with breast cancer survivors. In this qualitative study, four themes that the authors describe as limiting the ability of clinicians to address issues of sexuality in breast cancer survivors emerge. This study demonstrates that barriers to initiating conversations about sexual health have a lot more to do with the assumptions, attitudes, and knowledge of the clinicians' and their view of what is best for patient care than with the patient herself. (PsycINFO Database Record

The promise of canonical Wnt signaling modulators in enhancing bone repair.

The skeleton is vitally important for support, mechanical function and protection of internal organs. Over the last few decades, the molecular mechanisms by which bones develop and repair themselves have been the subject of intense research throughout the world. Particular attention has been paid to mesenchymal progenitors and the regulation of their differentiation to osteoblasts, the cells that build and repair bone. One of the major findings of these studies is that positive signaling by the canonical wingless (Wnt) pathway in mesenchymal progenitor cells is critical for the differentiation of the progenitors into osteoblasts. The subject of this review focuses on how perturbations of the Wnt pathway can adversely affect osteogenesis in disease and also, how pharmaceutical modulators of the Wnt pathway may be employed in the future to inhibit degenerative diseases of the bone and enhance repair.

How Wnt signaling affects bone repair by mesenchymal stem cells from the bone marrow.

Human mesenchymal stem cells (hMSCs) from bone marrow are a source of osteoblast progenitors in vivo, and under appropriate conditions they differentiate into osteoblasts ex vivo. The cells provide a convenient cell culture model for the study of osteogenic tissue repair in an experimentally accessible system. Recent advances in the field of skeletal development and osteogenesis have demonstrated that signaling through the canonical wingless (Wnt) pathway is critical for the differentiation of progenitor cell lines into osteoblasts. Inhibition of such signals can predispose hMSCs to cell cycle entry and prevent osteogenesis. Our investigation of the role of Wnt signaling in osteogenesis by hMSCs ex vivo has demonstrated that osteogenesis proceeds in response to bone morphogenic protein 2 stimulation and is sustained by Wnt signaling. In the presence of Dkk-1, an inhibitor of Wnt signaling, the cascade is disrupted, resulting in inhibition of osteogenesis. Peptide mapping studies have provided peptide Dkk-1 agonists and the opportunity for the production of blocking antibodies. Anti-Dkk-1 strategies are clinically relevant since high serum levels of Dkk-1 are thought to contribute to osteolytic lesion formation in multiple myeloma and possibly some forms of osteosarcoma. Specific inhibitors of glycogen synthetase kinase 3beta (GSK3beta), which mimic Wnt signaling, may also have a therapeutic benefit by enhancing in vitro osteogenesis despite the presence of Dkk-1. Antibodies that block Dkk-1 and GSK3beta inhibitors may provide novel opportunities for the enhancement of bone repair in a variety of human diseases such as multiple myeloma and osteosarcoma.

A pre-post pilot study of a brief, web-based intervention to engage disadvantaged smokers into cessation treatment.

BACKGROUND: People with low education and/or income are more likely to smoke, less likely to quit, and experience disparately poor health outcomes compared to those with education and income advantage. Cost-effective strategies are needed to inform and engage this group into effective cessation treatments. We developed a novel, web-based, motivational, decision-support system that was designed to engage disadvantaged smokers into tobacco cessation treatment. We piloted the system among smokers in a primary care safety net clinic. METHODS: Thirty-nine eligible subjects were assessed at baseline and used the decision-support system; 38 were assessed 2 months later. Chi-square or Fisher's exact tests were used to assess whether participants who used the program were more likely to use cessation treatment than a randomly selected group of 60 clinic patients. RESULTS: Thirty-nine percent of smokers initiated cessation treatment after using the decision-support system, compared to 3 percent of the comparison group (Fisher's exact = 21.2; p = 0.000). Over 10 percent achieved continuous abstinence over the 2-month follow-up. Users were satisfied with the program - 100 percent stated they would recommend it to a friend. CONCLUSIONS: Our data indicate that this web-based, motivational, decision-support system is feasible, satisfactory, and promising in its ability to engage smokers into cessation treatment in a primary care safety net clinic. Further evaluation research is warranted.

Relationship-centered administration: transferring effective communication skills from the exam room to the conference room.

Medical researchers have shown that relationship-centered healthcare increases patient satisfaction and improves health outcomes. The components of relationship-centered healthcare--listening, sharing decision making, and respecting others--improve patient motivation and commitment to a plan of action. Currently, no data are available on the extent to which medical administrative settings adhere to relationship-centered principles. To begin to answer this question, we observed a convenience sample of 45 meetings in healthcare settings to assess the frequency and types of relationship-centered behaviors shown by group leaders. Our results provide preliminary data that leaders, especially female leaders, praised the value of group member efforts and encouraged members to provide input. Less frequently employed relationship-centered behaviors included providing a verbal summary of a discussion, responding to feelings expressed by members, and setting explicit agendas. Finally, we found some provocative associations. Female leaders received higher satisfaction ratings, and male leaders were more verbally dominant. Similar to physician-patient interaction, new topics for discussion are less likely to arise spontaneously late in a meeting if early agenda setting is utilized. To our knowledge, this is the first such study in a medical setting. Our findings encourage those who chair meetings to reflect on the extent to which they use a collaborative approach and offer specific content areas on which to focus. Further research on the concept and outcomes of relationship-centered administrative approach is warranted.

Push and pull: resolving differences of opinion during meetings.

Consider the results of a recent study that looks at how to handle differences of opinions among physicians and other health care staff, including the ways that "push" and "pull" statements affect the outcomes of meetings.

Replication attempt: "Effect of BMAP-28 antimicrobial peptides on Leishmania major promastigote and amastigote growth: role of leishmanolysin in parasite survival".

This study describes an attempt to replicate experiments from the paper "Effect of BMAP-28 Antimicrobial Peptides on Leishmania major Promastigote and Amastigote Growth: Role of Leishmanolysin in Parasite Survival," which was submitted to the Reproducibility Initiative for independent validation. The cathelicidin bovine myeloid antimicrobial peptide 28 (BMAP-28) and its isomers were previously shown to have potent antiparasitic activity against Leishmania major. We tested the effectiveness of L-BMAP-28 and two of its isomers, the D-amino acid form (D-BMAP-28) and the retro-inverso form (RI-BMAP-28), in both unamidated and amidated forms, as anti-leishmanial agents against Leishmania major promastigotes in vitro. We observed that L-BMAP-28, as well as its D and RI isomers, demonstrate anti-leishmanial activity against L. major promastigotes in vitro. The inhibitory effect was lower than what was seen in the original study. At 2 µM of amidated peptides, the viability was 94%, 36%, and 66% with L-, D- and RI-peptides, versus 57%, 6%, and 18% in the original study.

An open investigation of the reproducibility of cancer biology research.

It is widely believed that research that builds upon previously published findings has reproduced the original work. However, it is rare for researchers to perform or publish direct replications of existing results. The Reproducibility Project: Cancer Biology is an open investigation of reproducibility in preclinical cancer biology research. We have identified 50 high impact cancer biology articles published in the period 2010-2012, and plan to replicate a subset of experimental results from each article. A Registered Report detailing the proposed experimental designs and protocols for each subset of experiments will be peer reviewed and published prior to data collection. The results of these experiments will then be published in a Replication Study. The resulting open methodology and dataset will provide evidence about the reproducibility of high-impact results, and an opportunity to identify predictors of reproducibility.

An innovative model for systems-based curriculum: the complex continuity clinic.

Dealing with complexity in a healthcare context requires the recognition of multiple variables impacting the interaction between the patient, the provider, and the care delivery system, resulting in situations in which usual treatments do not work as well as patients and clinicians expect. The Complex Continuity Clinic is presented as an innovative model for understanding and responding to complexity, particularly in a medical education setting, and for implementing different patient-engagement strategies. "Real world" clinical examples are provided to illustrate how pioneering approaches that embrace complex biopsychosocial health issues can result in higher quality of care and potentially reduced costs.

A crosstalk between myeloma cells and marrow stromal cells stimulates production of DKK1 and interleukin-6: a potential role in the development of lytic bone disease and tumor progression in multiple myeloma.

Multiple myeloma (MM) is a malignancy of antibody-secreting plasma cells. B-cell plasmacytomas stimulate bone resorption and angiogenesis, resulting in osteolytic lesions in the skeleton which persist upon successful treatment of the malignancy with chemotherapy. We found that an interaction between MM cells and mesenchymal stem cells (MSCs) from bone marrow stroma results in the formation and persistence of osteolytic bone lesions. It is known that MM cells activate osteoclast activity and secrete high levels of the Wnt inhibitor, Dickkopf-1, which prevents MSCs from differentiating into osteoblasts. We show that the Wnt signaling activator 6-bromoindirubin-3'-monoxime (BIO) releases MSCs from the osteoinhibitory effects of Dickkopf-1, whereas LiCl treatment does not. Additionally, we show that the >5-kDa fraction of MSC-conditioned medium promotes the proliferation of Dickkopf-1-secreting MM cells and that an interleukin-6 (IL-6)-neutralizing antibody blocks this effect. IL-6 expression levels were higher in undifferentiated MSCs than in MSCs treated with osteogenic medium, remained high in the presence of Dkk1, and were reduced by BIO treatment. Therefore, BIO treatment reduces the MSC-stimulated proliferation of MM cells and may enable MSCs to repair existing osteolytic lesions.