A Pilot Randomized Controlled Trial of the Family Assessment and Feedback Intervention (FAFI): Effects on Mental Health Literacy and Attitudinal Engagement with Health Supports and Services.

This randomized controlled trial tested the Family Assessment and Feedback Intervention (FAFI), a new intervention to enhance family engagement with emotional and behavioral health services. The FAFI is a guided conversation with families about results of their multidimensional assessment that is set in the context of motivational enhancement. It differs from other assessment-with-feedback interventions by extending the focus of assessment beyond the target child to parents and the family environment, addressing parental emotional and behavioral problems and competencies, spanning a broad range of children's and parents' strengths and difficulties, and being generalizable to many settings and practitioners. Participants were 81 families in primary care pediatrics. The FAFI was associated with a significant increase in parental mental health literacy and with an increase in parental attitudinal engagement with health supports and services that closely approached statistical significance (p = .052), while controlling for children's age and gender and family socioeconomic status.

The Vermont Family Based Approach in Primary Care Pediatrics: Effects on Children's and Parents' Emotional and Behavioral Problems and Parents' Health-Related Quality of Life.

This randomized controlled trial tested the Vermont Family Based Approach (VFBA) in primary care pediatrics. The VFBA is a model of healthcare delivery that shifts the focus from the individual to the family, emphasizes emotional and behavioral health, and uses evidence-based health promotion/prevention along with the treatment of emotional and behavioral problems. Participants were 81 families of 3-15-year-olds. For children, the VFBA was associated with greater reductions than the Control condition on the Child Behavior Checklist Emotionally Reactive, Withdrawn, Sleep Problems, Aggressive Behavior and Total Problems scales. For parents, the VFBA was associated with greater reductions than the Control condition on the Adult Self-Report Anxious/Depressed, Rule-Breaking Behavior, Internalizing Problems and Total Problems scales. The VFBA was also associated with greater improvement than the Control condition in the parents' health-related quality of life, as indicated by all scales of the Medical Outcomes Study Health Survey.

Comparison of the Comprehensive Complication Index and Clavien-Dindo systems in predicting perioperative outcomes following radical nephroureterectomy.

BACKGROUND: Complications can occur following radical nephroureterectomy (RNU) in 20-40% of patients. The Comprehensive Complication Index (CCI) is an alternative grading system to the Clavien-Dindo (CD) grading system that aggregates all complications experienced by a patient on a continuous (as opposed to categorical) scale. We investigate whether the cumulative nature of CCI renders it superior to CD in predicting perioperative course after RNU. METHODS: The records of 596 patents who underwent RNU at 7 academic medical centers from 2005 to 2015 were reviewed. Complications occurring within 30 days of RNU were annotated using both the CD and CCI classification systems. Logistic regression was used to determine associations between CD and CCI with perioperative covariates as well as measures of convalescence [hospital length of stay (LOS) and readmission]. RESULTS: A total of 377 men and 219 women with a median age of 71, BMI of 27, and Charlson comorbidity score of 4 were included. Over half underwent a minimally invasive RNU. Median LOS following RNU was 6.0 days (range, 1-37 days) and readmission within 30-days occurred in 45 (8%) patients. Overall, 136 patients (23%) experienced a post-operative complication with 91 having a single complication and 45 with multiple (range, 2-6); 44 (7%) patients had Clavien III or greater complications, and the median CCI for those patients experiencing a complication was 20.9 (range, 8.7-100). Both the upper quartile of CCI (≥75th %) and major CD complications were associated with higher baseline Charlson score, ECOG ≥2, and CKD stage ≥ III (all P<0.05). However, only the upper quartile of CCI was associated with LOS (8.9 vs. 5.4 days, P<0.01) and hospital readmission (OR 3.2, 95% CI: 1.9-5.6, P=0.02) after RNU. CONCLUSIONS: The CD and CCI classification systems both are associated with similar baseline and perioperative characteristics for RNU patients. However, the cumulative nature of the CCI allows for superior prediction of postoperative course after RNU including LOS and readmission.

Patient-Reported Quality of Life and Convalescence After Minimally Invasive Kidney Cancer Surgery.

OBJECTIVE: To better characterize recovery after minimally invasive kidney surgery, we present a study describing patient-reported health-related quality of life (HRQOL) following minimally invasive radical nephrectomy (RN) and partial nephrectomy (PN). METHODS: Patients who underwent minimally invasive PN or RN for renal cancer were invited to enroll in a prospective, patient-reported HRQOL study using the Convalescence and Recovery Evaluation (CARE) instrument and Short Form-12. Patients completed questionnaires at baseline, 2, 4, 8, and 12 weeks after surgery. Mixed repeated measures model were used to assess time effect on HRQOL scores and predictors of scores within each surgery groups. RESULTS: One hundred seventy-seven patients were included in the study: 50 had RN and 127 had PN. At 2 weeks, both groups had significant decreases in Overall CARE, as well as the Pain, Gastrointestinal, and Activity domain scores which remained slightly below baseline at 4 weeks. At 4 weeks only 50% of patients in both the RN and PN cohorts returned to baseline overall CARE score. By 12 weeks 82% returned to baseline overall CARE score in the RN group while 76% of patients did so in the PN group. CONCLUSION: Convalescence after minimally invasive renal surgery can often extend beyond 4 weeks post-treatment in PN and RN subjects. This information may be used to provide more accurate preoperative counseling in an attempt to improve overall patient satisfaction.

Health Promotion in Primary Care Pediatrics: Initial Results of a Randomized Clinical Trial of the Vermont Family Based Approach.

The Vermont Family Based Approach (VFBA) is an innovative approach to healthcare delivery that addresses challenges of the healthcare system in the United States. The authors conducted a randomized controlled trial of the VFBA at a primary care pediatric clinic. The goal of the trial was to test the feasibility of the VFBA in pediatrics and to improve healthcare engagement and health outcomes for families. This article presents initial results of the trial on feasibility and engagement. The VFBA was found feasible and was associated with a significant increase in engagement with health and wellness supports and services.

Societal costs of localized renal cancer surgery.

INTRODUCTION: Hospital-related costs of renal cancer surgery have been described, but the societal costs of surgery-related lost productivity are poorly understood. We estimated the societal cost of renal cancer surgery by assessing surgery-related time off work (TOW) taken by patients and their caretakers. MATERIALS AND METHODS: A total of 413 subjects who underwent partial or radical nephrectomy enrolled in an IRB-approved prospective study received an occupational survey assessing employment status, work physicality, income, surgery-related TOW, and caretaker assistance. We excluded subjects with incomplete occupational information or metastatic disease. We estimated potential wages lost using individual income and TOW, and used logistic regression to evaluate for factors predictive of TOW > 30 days. RESULTS: Of the 219 subjects who responded, 138 were employed at time of surgery. Ninety-seven subjects returned to work, met the inclusion criteria, and were analyzed. Mean age was 54 and 56% of subjects had sedentary jobs. TOW ranged from 7 to 92 days; mean and median TOW was 35 and 33 days, respectively and 58% of subjects took > 30 days off. Mean potential wages lost for TOW was $10,152. Eighty-three percent of subjects had at least one caretaker take TOW (mean/median caretaker TOW: 11/7 days, respectively) to assist in recovery. Subjects with sedentary jobs were less likely to take > 30 days off (OR 0.30; 95% CI 0.09-0.99). CONCLUSIONS: Most renal cancer surgery patients take over 1 month off work. Recognizing the associated societal costs may allow better adjustment of patient expectations, and more comprehensive cost-effectiveness analyses in renal cancer care.

Clinical Use of Expanded Prostate Cancer Index Composite for Clinical Practice to Assess Patient Reported Prostate Cancer Quality of Life Following Robot-Assisted Radical Prostatectomy.

PURPOSE: EPIC-CP (Expanded Prostate Cancer Index Composite for Clinical Practice) is a short questionnaire that comprehensively measures patient reported health related quality of life at the point of care. We evaluated the feasibility of using EPIC-CP in the routine clinical care of patients with prostate cancer without research infrastructure. We compared longitudinal patient and practitioner reported prostate cancer outcomes. MATERIALS AND METHODS: We reviewed health related quality of life outcomes in 482 patients who underwent radical prostatectomy at our institution from 2010 to 2014. EPIC-CP was administered and interpreted in routine clinical practice without research personnel. We compared practitioner documented rates of incontinence pad use and functional erections to patient reported rates using EPIC-CP. RESULTS: A total of 708 EPIC-CP questionnaires were completed. Mean urinary incontinence domain scores were significantly higher (worse) than baseline (mean ± SD 0.6 ± 0.2) 3 and 6 months after treatment (mean 3.1 ± 2.3 and 2.2 ± 2.1, respectively, each p <0.05) but they returned to baseline at 12 months (mean 1.6 ± 1.7, p >0.05). Mean sexual domain scores were significantly worse than baseline (mean 2.4 ± 2.8) at all posttreatment time points (each p <0.05). Practitioners significantly overestimated incontinence pad-free rates at 3 months (48% vs 39%) and functional erection rates at 3 months (18% vs 12%), 6 months (38% vs 23%) and 12 months (45% vs 23%, each p <0.05). CONCLUSIONS: EPIC-CP is feasible to use in the routine clinical care of patients with prostate cancer without requiring a research infrastructure. Using EPIC-CP in clinical practice may help practitioners objectively assess and appropriately manage posttreatment side effects in patients with prostate cancer.

Suicide by cop: clinical risks and subtypes.

This study examines whether clinical classification schemes from general suicide research are applicable for cases of suicide by cop (SbC) and whether there are indicators as to why the police might be engaged in the suicide. Using archival law enforcement data, 13 clinical risks were examined among 68 cases of SbC using exploratory factor analysis and k-means cluster analysis. Three subtypes of SbC cases emerged: Mental Illness, Criminality, and Not Otherwise Specified. The subtypes varied significantly on their levels of mental illness, substance use, and criminal activity. Findings suggest that reducing fragmentation between law enforcement and mental health service providers might be a crucial goal for suicide intervention and prevention, at least among cases of SbC.

Police officers who commit suicide by cop: a clinical study with analysis.

Suicide by cop has become a familiar topic among members of law enforcement, mental health professionals, and the general public. This paper presents two cases where police officers chose to commit suicide by getting other police officers to kill them. The two police officers studied, by examination of closed case files, were found to be similar to civilians who committed suicide by cop on several demographic (gender, age, history of mental illness, and suicide attempts), and situational (stress factors, trigger) variables. The cases help us to understand possible motives and management for individuals who choose to end their life in this manner.