Determinants of Exposure Therapy Implementation in Clinical Practice for the Treatment of Anxiety, OCD, and PTSD: A Systematic Review.

Exposure therapy (ET) forms a vital part of effective psychotherapy for anxiety-related presentations including anxiety disorders, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD), and is often underutilised in clinical practice. Using the Theoretical Domains Framework (TDF), this systematic review synthesised existing literature on the determinants of ET implementation for anxiety-related presentations and examined differences across presentations and developmental subgroups. Fifty-two eligible studies were assessed using the Mixed Methods Appraisal Tool, with 389 results (99%) mapped onto the TDF. Results suggested that clinicians' negative beliefs about the consequences of ET were commonly associated with reduced implementation. It also appeared that whilst broad unspecified ET training may be related to improved implementation for anxiety disorders; greater implementation for complex presentations (i.e., PTSD) likely requires more specialised training involving practical components. A subset of domains (e.g., social/professional role and identity) accounted for most results, whilst some remain unexplored (i.e., optimism; reinforcement; memory, attention, and decision processes) or underexplored (i.e., behavioural regulation). Likewise, specific presentations and developmental subgroups (i.e., PTSD and adults) represented a greater proportion of results in the literature than others (i.e., OCD and youth). Future research exploring ET implementation, across specific presentations and developmental subgroups, would benefit from integrating implementation science frameworks to guide the development of targeted, comprehensive strategies to close the research-practice gap of ET for the treatment of anxiety-related presentations.

Improving patient flow and timeliness in the diagnosis and management of breast abnormalities: the impact of a rapid diagnostic unit.

BACKGROUND: Efforts to streamline the diagnosis and treatment of breast abnormalities are necessary to limit patient anxiety and expedite care. In the present study, we examined the effect of a rapid diagnostic unit (rdu) on wait times to clinical investigations and definitive treatment. METHODS: A retrospective before-after series, each considering a 1-year period, examined consecutive patients with suspicious breast lesions before and after initiation of the rdu. Patient consultations, clinical investigations, and lesion characteristics were captured from time of patient referral to initiation of definitive treatment. Outcomes included time (days) to clinical investigations, to delivery of diagnosis, and to management. Groups were compared using the Fisher exact test or Student t-test. RESULTS: The non-rdu group included 287 patients with 164 invasive breast carcinomas. The rdu group included 260 patients with 154 invasive carcinomas. The rdu patients had more single visits for biopsy (92% rdu vs. 78% non-rdu, p < 0.0001). The rdu group also had a significantly shorter wait time from initial consultation to delivery of diagnosis (mean: 2.1 days vs. 16.7 days, p = 0.0001) and a greater chance of receiving neoadjuvant chemotherapy (37% vs. 24%, p = 0.0106). Overall time from referral to management remained statistically unchanged (mean: 53 days with the rdu vs. 50 days without the rdu, p = 0.3806). CONCLUSIONS: Introduction of a rdu appears to reduce wait times to definitive diagnosis, but not to treatment initiation, suggesting that obstacles to care delivery can occur at several points along the diagnostic trajectory. Multipronged efforts to reduce system-related delays to definitive treatment are needed.

Improved efficiency of heat generation in nonlinear dynamics of magnetic nanoparticles.

The deterministic Landau-Lifshitz-Gilbert equation has been used to investigate the nonlinear dynamics of magnetization and the specific loss power in magnetic nanoparticles with uniaxial anisotropy driven by a rotating magnetic field. We propose a new type of applied field, which is "simultaneously rotating and alternating," i.e., the direction of the rotating external field changes periodically. We show that a more efficient heat generation by magnetic nanoparticles is possible with this new type of applied field and we suggest its possible experimental realization in cancer therapy which requires the enhancement of loss energies.

An International Multicenter Review of the Malignancy Rate of Excised Papillomatous Breast Lesions.

BACKGROUND: Papillary lesions of the breast are a relatively rare, but heterogeneous group ranging from benign to atypical and malignant. Debate exists regarding the optimal management of these lesions. In the absence of more accurate risk-stratification models, traditional management guidelines recommend surgical excision, despite the majority of lesions proving benign. This study sought to determine the rate of malignancy in excised breast papillomas and to elucidate whether there exists a population in which surgical excision may be unnecessary. METHODS: A multicenter international retrospective review of core biopsy diagnosed breast papillomas and papillary lesions was performed between 2009 and 2013, following institutional ethical approval. Patient demographics, histopathological, and radiological findings were recorded. All data was tabulated, and statistical analysis performed using Stata. RESULTS: A total of 238 patients were included in the final analysis. The age profile of those with benign pathology was significantly younger than those with malignant pathology (p < 0.001). Atypia on core needle biopsy was significantly associated with a final pathological diagnosis of malignancy (OR = 2.73). The upgrade rate from benign core needle biopsy to malignancy on the final pathological sample was 14.4 %; however, only 3.7 % had invasive cancer. CONCLUSIONS: This international dataset is one of the largest in the published literature relating to breast papillomas. The overall risk of malignancy is significantly associated with older age and the presence of atypia on core needle biopsy. It may be possible to stratify higher-risk patients according to age and core needle biopsy findings, thereby avoiding surgery on low-risk patients.

Magnetic particle hyperthermia: power losses under circularly polarized field in anisotropic nanoparticles.

The deterministic Landau-Lifshitz-Gilbert equation has been used to investigate the nonlinear dynamics of magnetization and the specific power loss in magnetic nanoparticles with uniaxial anisotropy driven by a rotating magnetic field, generalizing the results obtained for the isotropic case found by P. F. de Châtel, I. Nándori, J. Hakl, S. Mészáros, and K. Vad [J. Phys. Condens. Matter 21, 124202 (2009)]. As opposed to many applications of magnetization reversal in single-domain ferromagnetic particles, where losses must be minimized, in this paper, we study the mechanisms of dissipation used in cancer therapy by hyperthermia, which requires the enhancement of energy losses. We show that for circularly polarized field, the energy loss per cycle is decreased by the anisotropy compared to the isotropic case when only dynamical effects are taken into account. Thus, in this case, in the low-frequency limit, a better heating efficiency can be achieved for isotropic nanoparticles. The possible role of thermal fluctuations is also discussed. Results obtained are compared to experimental data.

Injecting equipment sharing and perception of HIV and hepatitis risk among injecting drug users in Budapest.

In central European states, rates of HIV among injection drug users (IDUs) have been low although Hepatitis C (HCV) infection is widespread. The goal of our study was to assess HIV infection, risk perceptions and injecting equipment sharing among IDUs in Budapest, Hungary. Altogether 150 IDUs were interviewed (121 structured interviews between 1999 and 2000 and 29 ethnographic interviews between 2003 and 2004). The majority of them injected heroin (52% and 79%) and many injected amphetamines (51% and 35%). One person tested positive for HIV. Two thirds (68%) shared injecting equipment (syringes, cookers and filters). Some participants said they shared syringes because they were not carrying them for fear of police harassment and that they reused filters as a backup drug supply. In multivariate analysis, sharing of injecting equipment was associated with higher perceived susceptibility to HIV/AIDS, lower self-efficacy for sterile equipment use, higher motivation to comply with peer pressure to use dirty injecting equipment and with having a criminal record. The high levels of injecting risk-behaviors found in this study are a cause for serious concern. Interventions for HIV-prevention need to address not only sharing syringes but also sharing and reusing of other injecting equipment and drug filters.

The effect of diazepam and promethazine treatment during pregnancy on the somatic development of human offspring.

The postnatal longitudinal somatic, neurological, mental, and behavioral developments were studied in children at birth, 8, 15, and 24 months of life, whose mothers were treated during pregnancy with clinical doses of diazepam (n = 126) and promethazine (n = 127) and whose mothers were unexposed. The latter group was differentiated in negative (n = 256) and positive (n = 102) control children. The positive control group involved mothers who had pregnancy complications similar to those of mothers in the drug groups but who were not treated with CNS-active drugs during pregnancy. It is very difficult to recruit persons for the study and control groups who are appropriate for comparative evaluation. Only firstborns and the so-called "normal" newborn infants were studied; children with low birth weight, major abnormalities, severe neonatal diseases, etc., were excluded. In this article the study design, study materials, and somatic (weight, length, head circumference) development are described. At birth, children had a lower weight in the diazepam group, but it was not noted at the eighth month of postnatal life.

Drug use by the members of youth subcultures in Hungary.

In our survey we tape recorded sociological interviews with 234 members of youth subcultures in Hungary. Further, we conducted participant observations. This is the first survey of the kind in Hungary. In this study we present findings concerning the familial, sociodemographical characteristics of the persons and also the data related to their course of life and their career in the subculture. We compare the drug-user youths in the subculture groups and the ones in the same groups who are not drug users. The differences are above all due to the course of life and the special features of their careers in the subculture. The findings allow the subculture drug scene in Hungary to be mapped and therefore made better known.

[Evaluation of the effect of drug intake during pregnancy based on the Monitoring Surveillance of the Pathogenesis of Congenital Anomalies]. / A terhesség alatti gyógyszerszedés értékelése a veleszületett rendellenesség felügyelet kóroki monitora alapján.

The data of the Hungarian Case-Control Surveillance of Congenital Anomalies, 1980-1987 were evaluated concerning drug intake during pregnancy in 10,698 index patients, 21,564 negative controls and 828 positive controls. Excluding pregnancy supplements, the proportion of no drug users was about 30% and the mean number of drugs used was 2.0 in negative control group. These figures did not differ significantly from data of study and positive control groups. The analysis of most commonly used drugs indicated an extremely high proportion of hormonal support therapy. The teratogenic effect of several human teratogenic drugs was confirmed. However, their use is relatively rare and their attributable risk within the etiology of congenital anomalies is low, at about 0.3-1.0%. At present the teratogenic risk of drugs in humans is exaggerated and it has several unfortunate con-sequences: negligence of necessary drug use, unnecessary anxiety in pregnant women, termination of planned pregnancies without any reasonable cause.

Evaluation of drug intake during pregnancy in the Hungarian Case-Control Surveillance of Congenital Anomalies.

The data of the Hungarian Case-Control Surveillance of Congenital Anomalies, 1980-1987, were evaluated concerning drug intake during pregnancy in 10,698 index patients, 21,546 negative controls, and 828 positive controls (Down syndrome). Excluding pregnancy supplements, the proportion of no drug use was about 30% and the mean number of drugs used was 2.0 in the negative control group. These figures did not differ significantly from data of study and positive control groups. The analysis of most commonly used drugs indicated an extremely high proportion of hormonal support therapy. The teratogenic effect of several human teratogenic drugs was confirmed. However, their use is relatively rare and their attributable risk within the etiology of congenital anomalies is low, at about 0.3-1.0%. At present the teratogenic risk of drugs in humans is exaggerated and it has several unfortunate consequences: negligence in necessary drug use, unnecessary anxiety in pregnant women, and termination of planned pregnancies without any reasonable cause.