Randomized waitlist-controlled trial of buried in treasures facilitated support groups and in-home uncluttering (BIT+) for hoarding disorder.

OBJECTIVE: The Buried in Treasures (BIT) workshop is a promising treatment for hoarding disorder (HD), though many participants struggle with home uncluttering. This randomized waitlist-controlled trial investigated the efficacy of a version of BIT, augmented with in-home uncluttering practice (BIT+). METHOD: Adults (N = 41) with hoarding disorder were recruited from the community and randomly assigned to BIT+ or waitlist. BIT+ consisted of 16 sessions of the BIT workshop and 10 uncluttering home visits over 18 weeks. Outcome measures included the Saving Inventory-Revised (self-report) and the Clutter Image Rating Scale (self and independent evaluator rated). Between group repeated measures analyses using general linear modeling examined the effect of BIT+ vs waitlist control on hoarding symptoms after 18 weeks. Within group analyses examined pre-post effects for all BIT+ participants combined after 18 weeks. RESULTS: After 18 weeks, BIT+ participants benefited significantly more than waitlist controls on hoarding severity with large effect size (Cohen's d = 1.5, p < .001). BIT+ was also associated with improvement reductions in hoarding symptoms, clutter, and functional impairment. CONCLUSIONS: The BIT+ intervention offers promise as a treatment option for hoarding. Adding in-home uncluttering practice may incrementally improve discarding practices. Future controlled trials are warranted.

Whole-genome risk prediction of common diseases in human preimplantation embryos.

Preimplantation genetic testing (PGT) of in-vitro-fertilized embryos has been proposed as a method to reduce transmission of common disease; however, more comprehensive embryo genetic assessment, combining the effects of common variants and rare variants, remains unavailable. Here, we used a combination of molecular and statistical techniques to reliably infer inherited genome sequence in 110 embryos and model susceptibility across 12 common conditions. We observed a genotype accuracy of 99.0-99.4% at sites relevant to polygenic risk scoring in cases from day-5 embryo biopsies and 97.2-99.1% in cases from day-3 embryo biopsies. Combining rare variants with polygenic risk score (PRS) magnifies predicted differences across sibling embryos. For example, in a couple with a pathogenic BRCA1 variant, we predicted a 15-fold difference in odds ratio (OR) across siblings when combining versus a 4.5-fold or 3-fold difference with BRCA1 or PRS alone. Our findings may inform the discussion of utility and implementation of genome-based PGT in clinical practice.

Examining subjective sleep quality in adults with hoarding disorder.

Hoarding disorder (HD), characterized by difficulty parting with possessions and functionally impairing clutter, affects 2-6% of the population. Originally considered part of Obsessive-Compulsive Disorder (OCD), HD became a distinct diagnostic entity in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013. While sleep impacts OCD, little is known about sleep in HD. As HD patients often report poor sleep in clinical settings, understanding global subjective sleep quality and disturbances may lead to novel therapeutic targets. To address this gap, the authors used a sample of convenience: an existing data set designed to screen research study eligibility and explore the psychopathology and phenomenology of OCD and HD. The data set included information collected from individuals with HD (n = 38), OCD (n = 26), and healthy participants (n = 22) about insomnia, sleep quality, and mood using interviews and structured instruments including the Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI), and Depression Anxiety Stress Scales (DASS). In this data set, HD and OCD groups reported significantly greater insomnia symptoms and poorer sleep quality compared with healthy controls while controlling for depression, age, and gender. A sizable minority of HD and OCD individuals met criteria for comorbid sleep disorders. OCD and HD groups differed in delayed sleep phase prevalence. To our knowledge, this is the first study examining subjective sleep quality and insomnia in HD as compared to healthy individuals and those with OCD, while controlling for relevant clinical characteristics. Given that there are evidence-based treatments for insomnia and other sleep disorders, our study raises the possibility that treatment interventions targeting sleep may improve HD outcomes.

[Decrease of unnecessary chest x-rays in Intensive Care Unit: application of a combined cycle of quality improvement]. / La disminución de las radiografías de tórax innecesarias en la Unidad de Cuidados Intensivos: aplicación de un ciclo conjunto de mejora de la calidad.

PURPOSE: To demonstrate that interdisciplinary consensus improves the quality of work in the daily Intensive Care Unit (ICU), thus avoiding unnecessary routine x-ray examinations. We propose to monitor the results to maintain this low percentage of requests for x-rays. DESIGN: Cycle of improvement in care quality. SETTING: An 18-bed polyvalent ICU. PATIENTS: A random sample of patients admitted in ICU during one month. INTERVENTIONS: Establishment of basic agreed on protocol for routine chest portable x-ray (CPR) indications. After assessing the excessive amount of CPR according to those criteria, all intensivists accepted their application. Five years later, a second assessment of the degree of non-compliance was carried out and a monitoring schedule was established in order to avoid making unnecessary CPR again. Furthermore, a consensus between two intensivists was considered obligatory before a CPR request. Accordingly, all non-urgent CPR forms were signed by two intensivists, following the mentioned clinical criteria. VARIABLE: Unsuitable portable chest x-ray indications. RESULTS: In 1997, the overall non-compliance rate (ONCR) was 16.9%. After reducing it to 6.1%, lack of follow-up led to a non-compliance rate of 27.6% in 2003. Stable patients with uncomplicated ischemic heart disease (44.4% in 1997 and 53.8% in 2003) accounted for most of the inadequate ONCR indications. By using the consensus system for requesting routine portable x-rays that required the agreement of two intensivists achieved a reduction of non-compliance to 2.5% in 2003. The monitoring schedule designed has made it possible to follow the time of compliance degree and detect relaxation in the prescriptions. CONCLUSIONS: Unnecessary CPR can be easily reduced stressing our control in clinically stable patients. The requirement to justify a routine request (agreement between intensivists) makes it possible to decrease the number of CPRs. Periodic monitoring is the definitive tool for a successful improvement cycle.

La disminución de las radiografías de tórax innecesarias en la Unidad de Cuidados Intensivos: aplicación de un ciclo conjunto de mejora de la calidad / Decrease of unnecessary chest x-rays in Intensive Care Unit: application of a combined cycle of quality improvement

Objetivo. Demostrar que el consenso interdisciplinar mejora la calidad del trabajo en la Unidad de Cuidados Intensivos (UCI), evitando exploraciones radiológicas rutinarias innecesarias, planteándose una monitorización de los resultados para mantener este bajo porcentaje de peticiones. Diseño. Ciclo de mejora de calidad asistencial. Ámbito. UCI de 18 camas de carácter polivalente. Pacientes. Pacientes ingresados en la UCI en el periodo de un mes, durante el cual se hizo un muestreo aleatorio sistemático. Intervenciones. Establecimiento de un protocolo consensuado de petición de radiografías de tórax portátiles (RTP) rutinarias. Tras comprobar el exceso de RTP siguiendo estos criterios, se acordó con todos los intensivistas su aplicación. Cinco años después se volvió a valorar el grado de incumplimiento y se incluyó un calendario de monitorizaciones para evitar la vuelta al exceso de solicitudes no justificadas. Además se introdujo un sistema de petición consensuado entre dos intensivistas, de manera que todas las RTP programadas para cada día se solicitaban por parte de dos intensivistas, atendiendo a los mencionados criterios. Variable. Peticiones que incumplen el protocolo de RTP programada. Resultados. En 1997, el grado global de incumplimiento era del 16,9%. Tras reducirlo al 6,1%, la falta de control posterior llevó a que en 2003 fuese del 27,6%. Los pacientes estables con cardiopatía isquémica (44,4% y 53,8% de todos los incumplimientos en esos dos años) constituyen el grueso de las indicaciones inadecuadas. El uso de un modelo de solicitud que requiere del consenso de dos intensivistas consiguió una reducción del incumplimiento al 2,5% en 2003. El calendario de monitorización ha permitido seguir en el tiempo el grado de cumplimiento y detectar la relajación en la prescripción. Conclusiones. Las RTP innecesarias pueden reducirse fácilmente incidiendo sobre los pacientes clínicamente estables. La obligación de justificar una petición rutinaria (consenso entre intensivistas) permite disminuir el número de peticiones de RTP. La monitorización periódica es la herramienta final para el éxito del ciclo de mejora

Purpose. To demonstrate that interdisciplinary consensus improves the quality of work in the daily Intensive Care Unit (ICU), thus avoiding unnecessary routine x-ray examinations. We propose to monitor the results to maintain this low percentage of requests for x-rays. Design. Cycle of improvement in care quality. Setting. An 18-bed polyvalent ICU. Patients. A random sample of patients admitted in ICU during one month. Interventions. Establishment of basic agreed on protocol for routine chest portable x-ray (CPR) indications. After assessing the excessive amount of CPR according to those criteria, all intensivists accepted their application. Five years later, a second assessment of the degree of non-compliance was carried out and a monitoring schedule was established in order to avoid making unnecessary CPR again. Furthermore, a consensus between two intensivists was considered obligatory before a CPR request. Accordingly, all non-urgent CPR forms were signed by two intensivists, following the mentioned clinical criteria. Variable. Unsuitable portable chest x-ray indications. Results. In 1997, the overall non-compliance rate (ONCR) was 16.9%. After reducing it to 6.1%, lack of follow-up led to a non-compliance rate of 27.6% in 2003. Stable patients with uncomplicated ischemic heart disease (44.4% in 1997 and 53.8% in 2003) accounted for most of the inadequate ONCR indications. By using the consensus system for requesting routine portable x-rays that required the agreement of two intensivists achieved a reduction of non-compliance to 2.5% in 2003. The monitoring schedule designed has made it possible to follow the time of compliance degree and detect relaxation in the prescriptions. Conclusions. Unnecessary CPR can be easily reduced stressing our control in clinically stable patients. The requirement to justify a routine request (agreement between intensivists) makes it possible to decrease the number of CPRs. Periodic monitoring is the definitive tool for a successful improvement cycle

Demografía y asistencia social / Demography and social assistance

La política social del Estado mexicano constituye una área de consenso nacional que cuenta con una notable cobertura pública y privada. En los últimos años, con situaciones financieras difíciles, el Estado ha conservado y expandido los servicios sociales de apoyo a los sectores populares más vulnerables. Se han hecho esfuerzos por descentralizar servicios sociales, orientando las acciones hacia los grupos más desprotegidos. Junto al crecimiento de los servicios, tales como seguro social, servicios generales de salud, educación básica y formación técnico-profesional, se han impulsado programas de desarrollo integral de la familia. La política social debe, para que sea efectiva respecto al bienestar de la población, no sólo buscar una distribución racional de la población sino también impactar tanto en el crecimiento general de la ésta, como en el crecimiento de las ciudades, para que los beneficios y servicios les llegue a todos a los costos más bajos posibles. Por otra parte, el Sistema Nacional para el Desarrollo Integral de la Familia (DIF) es, en materia de asistencia social, la instancia institucional donde se concretiza la acción del Estado, al mismo tiempo que se le da unidad y dirección