Standardized Use of the Stanford Integrated Psychosocial Assessment for Transplantation in LVAD Patients.

BACKGROUND: Increased psychosocial risk portends poor outcomes following heart transplantation. The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a validated, psychosocial risk assessment tool that helps stratify candidates for transplantation. We assessed the impact of psychosocial factors as measured by the SIPAT on clinical outcomes following left ventricular assist device (LVAD) implantation at our institution. METHODS AND RESULTS: A total of 115 individuals (mean age: 57 years, 75.6% men) who underwent LVAD implantation, for either bridge-to-transplant (63%) or destination therapy, from 2014 to 2016 were included for analysis. Correlations between SIPAT scores, baseline characteristics, and post-LVAD outcomes were assessed through a retrospective correlational design. At 1 year post-LVAD, the higher risk SIPAT group had more emergency department visits, urgent clinic visits, and readmissions in univariate analysis (rate ratio 1.7 [95% confidence interval (CI) 1.0-2.7, P = .035]). After multivariate analysis, this association retained near-statistical significance (rate ratio 1.6 [95% CI 1.0-2.8, P = .051]). There was also a trend toward more device-associated infections (rate ratio 2.1 [95% CI 0.96-4.4, P = .064]). There was no difference in incidence of other adverse events or 1-year mortality between the 2 groups. CONCLUSIONS: Higher psychosocial risk per SIPAT in patients undergoing LVAD implantation is associated with more emergency room visits, urgent visits and readmissions over 1 year, but not LVAD-related complications or mortality. Use of the SIPAT tool may help identify patients at higher risk for hospitalization and/or urgent care beyond traditional factors, but should not preclude LVAD implantation.

Differentiation in social perception: Why later-encountered individuals are described more negatively.

According to the cognitive-ecological model of social perception, biases toward individuals can arise as by-products of cognitive principles that interact with the information ecology. The present work tested whether negatively biased person descriptions occur as by-products of cognitive differentiation. Later-encountered persons are described by their distinct attributes that differentiate them from earlier-encountered persons. Because distinct attributes tend to be negative, serial person descriptions should become increasingly negative. We found our predictions confirmed in six studies. In Study 1, descriptions of representatively sampled persons became increasingly distinct and negative with increasing serial positions of the target person. Study 2 eliminated this pattern of results by instructing perceivers to assimilate rather than differentiate a series of targets. Study 3 generalized the pattern from one-word descriptions of still photos of targets to multisentence descriptions of videos of targets. In line with the cognitive-ecological model, Studies 4-5b found that the relation between serial position and negativity was amplified among targets with similar positive attributes, zero among targets with distinct positive or negative attributes, and reversed among similar negative targets. Study 6 returned to representatively sampled targets and generalized the serial position-negativity effect from descriptions of the targets to overall evaluations of them. In sum, the present research provides strong evidence for the explanatory power of the cognitive-ecological model of social perception. We discuss theoretical and practical implications. It may pay off to appear early in an evaluation sequence. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Participants' experiences of mindfulness-based cognitive therapy: "It changed me in just about every way possible".

BACKGROUND: Mindfulness-Based Cognitive Therapy (MBCT) is a promising approach to help people who suffer recurrent depression prevent depressive relapse. However, little is known about how MBCT works. Moreover, participants' subjective experiences of MBCT as a relapse prevention treatment remain largely unstudied. AIM: This study examines participants' representations of their experience of MBCT and its value as a relapse-prevention program for recurrent depression. METHOD: Twenty people who had participated in MBCT classes for recurrent depression within a primary care setting were interviewed 12 months after treatment. The focus of the interview was on participants' reflections on what they found helpful, meaningful and difficult about MBCT as a relapse prevention program. Thematic analysis was used to identify the key patterns and elements in participants' accounts. RESULTS AND CONCLUSIONS: Four overarching themes were extracted: control, acceptance, relationships and struggle. The theoretical, clinical and research implications are discussed.

A Review of the Role of Non-Vitamin K Oral Anticoagulants in the Acute and Long-Term Treatment of Venous Thromboembolism.

Venous thromboembolism (VTE), which includes both deep vein thrombosis and pulmonary embolism (PE), is a very common disorder with high risk for recurrence and is associated with significant morbidity and mortality. The non-vitamin K oral anticoagulants (NOACs), which include dabigatran, rivaroxaban, apixaban, and edoxaban, have been shown to be noninferior to conventional anticoagulant therapy for the prevention of recurrent VTE and are associated with more favorable bleeding risk. Evidence from the treatment of VTE with traditional therapy (low molecular weight heparin and vitamin K antagonists) implies that extended or indefinite treatment reduces risk of recurrence. Recently, mounting evidence suggests a role for the extended use of NOACs to reduce the risk of VTE recurrence. This review summarizes the existing evidence for the extended use of NOACs in the treatment of VTE from phase III extension studies with dabigatran, rivaroxaban, and apixaban. Additionally, it examines and discusses the major society guidelines and how these recommendations may change physician practices in the near future.