INvestigation of the impact of a Pharmacist in a Hospital At Home Care Team (IN PHACT).

Background: In November 2020, Island Health, with the support of the British Columbia Ministry of Health, introduced the Hospital at Home (HaH) care model at Victoria General Hospital in Victoria, British Columbia. Given the acuity of the patients anticipated to receive care through this model, questions arose regarding how the delivery of clinical pharmacy services on which inpatients rely on could be included. With limited supporting evidence for the inclusion of a clinical pharmacist, Island Health launched the HaH program with 2 clinical pharmacists who provide services 7 days a week during daytime hours. The aim of this study is to assess the impact of the HaH pharmacist on patient care, from the perspective of the pharmacists serving in this role, patients, caregivers and program stakeholders. Methods: This prospective, observational mixed-methods study was conducted from December 2021 to March 2022. Data collection involved the HaH pharmacist documenting daily clinical activities and resolving drug therapy problems, patients and caregivers completing a 4-question postdischarge phone survey and program stakeholders completing a 9-question online survey and an optional 7-question interview. Results and Interpretation: It was found that one of the most significant roles the pharmacist plays is in identifying indications for medication therapy and making recommendations to initiate therapy where there is an absence. There was high congruence between patient, caregiver and stakeholder perceptions that the HaH pharmacist positively affects patient care within the Island Health model. Conclusion: This study provides support for the integration of a dedicated clinical pharmacist in the HaH care model.

Sequences in harmony: Cognitive interactions between musical and visual narrative structure.

From film and television to graphic storytelling, tonal music can accompany visual narratives in a variety of contexts. The apprehension of both musical and narrative sequences involves temporal categories in ordered patterning, which raises an interesting question: Do musical progressions and visual narratives rely on shared sequence processing mechanisms? If this is the case, then cues from music and sequential static images, when presented simultaneously, should interact during audiovisual online processing. We tested this question by measuring reaction times to target picture panels appearing in visual narrative (comic strip) sequences, which were presented panel by panel and synchronized with musical chord progressions. Image sequences were either coherent narratives or incoherent (random) panels, and they were aligned with musical accompaniment consisting of coherent tonal chord progressions or non-tonal (unrelated) chords. Reaction times were faster for target images in coherent sequences than incoherent sequences, and even faster for coherent images with tonal accompaniment than non-tonal chords. This indicated an interaction between sequential structures across domains. We take these results as evidence for a shared, domain-general sequence processing mechanism operating across music and visual narrative.

The ubiquitin-proteasome system and learning-dependent synaptic plasticity - A 10 year update.

Over 25 years ago, a seminal paper demonstrated that the ubiquitin-proteasome system (UPS) was involved in activity-dependent synaptic plasticity. Interest in this topic began to expand around 2008 following another seminal paper showing that UPS-mediated protein degradation controlled the "destabilization" of memories following retrieval, though we remained with only a basic understanding of how the UPS regulated activity- and learning-dependent synaptic plasticity. However, over the last 10 years there has been an explosion of papers on this topic that has significantly changed our understanding of how ubiquitin-proteasome signaling regulates synaptic plasticity and memory formation. Importantly, we now know that the UPS controls much more than protein degradation, is involved in plasticity underlying drugs of abuse and that there are significant sex differences in how ubiquitin-proteasome signaling is used for memory storage processes. Here, we aim to provide a critical 10-year update on the role of ubiquitin-proteasome signaling in synaptic plasticity and memory formation, including updated cellular models of how ubiquitin-proteasome activity could be regulating learning-dependent synaptic plasticity in the brain.

Acutely enhancing affective state and social connection following an online dance intervention during the COVID-19 social isolation crisis.

The COVID-19 pandemic has forced many throughout the world to isolate themselves from their respective communities to stop the spread of disease. Although this form of distancing can prevent the contraction of a virus, it results in social isolation and physical inactivity. Consequently, our communities have become heavily reliant on digital solutions to foster social connection and increase physical activity when forced to isolate. Dance is a multidimensional form of physical activity that includes sensory, motor, cognitive, rhythmic, creative, and social elements. Long-term, interventional studies in dance have shown positive effects on both mental and social health; however, little has been done to examine the acute effects and no studies to date have explored the relationship between the affective state and social outcomes of dance. We examined the hypothesis that online dance is associated with improvements in affective state and social connection during a time of social isolation, namely, the COVID-19 crisis. Healthy adults (age ≥ 18; n = 47) engaged in a single session of 60 min of self-selected online dance, completing a series of validated self-reported questionnaires before and after class. We found that online dance was associated with improvements in affective state as measured by increased positive affect and self-esteem and decreased negative affect and depressive symptoms. Additionally, online dance was associated with improvements in social and community connectedness. Further, we found that those who experienced the largest increases in self-esteem and decreases in negative affect demonstrated the largest gains in social connectivity. Although in-person dance classes may be optimal for formalized dance training, online dance instruction offers an accessible platform that can provide mental and social health benefits during the COVID-19 social isolation crisis. We conclude that through online dance, individuals can experience a connection between the body, mind, and community.

The Patient Lived-Experience of Ventral Capsulotomy for Obsessive-Compulsive Disorder: An Interpretive Phenomenological Analysis of Neuroablative Psychiatric Neurosurgery.

Ventral Capsulotomy (VC) is a surgical intervention for treatment-resistant Obsessive-Compulsive Disorder (OCD). Despite clinical studies, little is known about patient perception and lived experience after neurosurgery for severe OCD. To examine the lived experiences of patients who have undergone VC for severe, treatment-resistant OCD through qualitative analysis. We conducted semi-structured interviews with six participants treated with VC for OCD. Interviews were analyzed using Interpretive Phenomenological Analysis. The following themes emerged: (1) After years of conventional treatments, patients felt neurosurgery was their "last hope" and described themselves as "desperate," (2) While some described the surgery as a "supernatural experience," patients also demonstrated understanding of the scientific procedure, its risks and potential benefits, (3) The surgical experience itself was positive or neutral, which was linked to trust in the clinical team, (4) Post-surgery, participants described months of heightened fear as they awaited lesion formation and functional improvement. (5) Patients consistently contextualized outcome in the context of their own life goals. Patients undergoing VC have positive views of this neurosurgical intervention, but psychiatric neurosurgical teams should anticipate patient discomfort with the time needed to achieve behavioral improvement following surgery and emphasize the importance of post-operative psychiatric care.

Magnetic Resonance Imaging-Guided Laser Thermal Ventral Capsulotomy for Intractable Obsessive-Compulsive Disorder.

BACKGROUND: Obsessive-compulsive disorder (OCD) is a disabling condition characterized by intrusive thoughts and repetitive behaviors. A subset of individuals have severe, treatment-resistant illness and are nonresponsive to medication or behavioral therapies. Without response to conventional therapeutic options, surgical intervention becomes an appropriate consideration. OBJECTIVE: To report clinical outcomes and the safety profile of bilateral ventral anterior capsulotomy for OCD using magnetic resonance (MR)-guided laser interstitial thermal therapy (LITT) in 10 patients followed for 6 to 24 mo. METHODS: A total of 10 patients underwent LITT for severe OCD; 1 patient withdrew prior to follow-up. LITT is a minimally invasive ablative technique performed with precise targeting and use of thermography under MR guidance. Lesions of the ventral anterior limb of the internal capsule by other techniques have been shown to be efficacious in prior studies. RESULTS: A total of 7 of the 9 patients were considered full responders (77.8%; Yale-Brown Obsessive-Compulsive Scale change ≥35%). Adverse effects included transient apathy/amotivation postsurgery (2 patients). One patient had a small tract hemorrhage where the laser fiber traversed the cerebral cortex as well as persistent insomnia postsurgery. One individual died after a drug overdose 7 mo postsurgery, which was judged unrelated to the surgery. CONCLUSION: LITT ventral capsulotomy was generally well tolerated, with promising evidence of effectiveness in the largest such series to date. Results were comparable to those after gamma knife ventral capsulotomy, as well as ventral anterior limb deep brain stimulation.

Feasibility of Using Oral Fluid for Therapeutic Drug Monitoring of Antiepileptic Drugs.

Therapeutic drug monitoring (TDM) of antiepileptic drugs (AED) using blood is well established but limited by its invasiveness, accessibility, cost, interpretation errors, and related disturbances in protein binding. TDM using oral fluid (OF) could overcome these limitations. This paper provides a summary of the current evidence for using OF as a matrix to perform TDM of AEDs, as well as practical considerations. A literature search of MEDLINE, EMBASE, and the Cochrane Library was conducted on April 9, 2018 (and then updated on May 20, 2020) using all AEDs as keywords along with "oral fluid," "saliva," "salivary," "seizure," "epilepsy," "antiepileptic," and "anticonvulsant." A total of 18 relevant articles were found and included in this review. There is evidence to suggest that AED TDM using OF is feasible and that reference ranges can be calculated for the following drugs: carbamazepine, ethosuximide, lacosamide, lamotrigine, levetiracetam, oxcarbazepine, phenobarbital, phenytoin, primidone, topiramate, and valproic acid. For all other AEDs, there is either a lack of evidence on the feasibility of TDM using OF or the evidence indicates that TDM using OF is not feasible. Practical considerations should include the timing and method of OF collection (stimulated or unstimulated) due to their probable impact on the reliability of AED TDM. Using OF may improve the acceptability and accessibility and reduce the cost of AED TDM. Clinical implementation requires standardized collection protocols, more rigorously defined OF reference ranges, and further studies to determine the relevance to clinically important outcomes.

Using Technology to Support Expectant and Parenting Youth through Case Management: Lessons Learned in the Field.

INTRODUCTION: The Support. Empower. Learn. Parenting Health Initiative (SELPHI) provides expectant and parenting youth ages 16-24 in Philadelphia with supports to improve educational, social, and economic outcomes to shape their health and the health of their children. Phone, text, video-based, and social media communication technology is built in to SELPHI's program design to facilitate case management and connect clients to a broad referral network. Given the novelty of using information and communication technology (ICT) in case management, the reported lessons learned seek to give providers a specific and nuanced picture of ICT in case management. METHODS: In its initial 6-month implementation period, SELPHI's five case managers, called Navigators, served 59 clients. Data from feedback surveys and case records were collected from clients and Navigators. Data included client demographic characteristics, needs assessment, and contact records to inform continuous quality improvement (CQI). RESULTS: ICT's benefits included having multiple ways to connect to difficult-to-reach clients, the ability to be more responsive to clients, and the flexibility to address scheduling and transportation barriers. ICT's challenges are related to Navigators' boundary setting, limitations on rapport building, and data security considerations. CQI data are presented to illustrate the lessons learned. Text messages were the most prevalent ICT; phone calls were most successful in engaging clients. Clients' ICT preferences differed by purpose of communication. DISCUSSION: Findings suggest that programs should understand the nuances of client contact preferences. To maximize the benefits of ICT, programs must develop or adapt protocols based on preference and purpose of communication.