Delayed Cerebral Ischaemia After Subarachnoid Haemorrhage: Looking Beyond Vasospasm.

Delayed cerebral ischaemia after subarachnoid haemorrhage: looking beyond vasospasm.

Filed under: Depression Treatment

Br J Anaesth. 2012 Sep; 109(3): 315-29
Rowland MJ, Hadjipavlou G, Kelly M, Westbrook J, Pattinson KT

Despite improvements in the clinical management of aneurysmal subarachnoid haemorrhage over the last decade, delayed cerebral ischaemia (DCI) remains the single most important cause of morbidity and mortality in those patients who survive the initial bleed. The pathological mechanisms underlying DCI are still unclear and the calcium channel blocker nimodipine remains the only therapeutic intervention proven to improve functional outcomes after SAH. The recent failure of the drug clazosentan to improve functional outcomes despite reducing vasoconstriction has moved the focus of research into DCI away from cerebral artery constriction towards a more multifactorial aetiology. Novel pathological mechanisms have been suggested, including damage to cerebral tissue in the first 72 h after aneurysm rupture (‘early brain injury’), cortical spreading depression, and microthrombosis. A greater understanding of the significance of these pathophysiological mechanisms and potential genetic risk factors is required, if new approaches to the prophylaxis, diagnosis, and treatment of DCI are to be developed. Furthermore, objective and reliable biomarkers are needed for the diagnosis of DCI in poor grade SAH patients requiring sedation and to assess the efficacy of new therapeutic interventions. The purpose of this article is to appraise these recent advances in research into DCI, relate them to current clinical practice, and suggest potential novel avenues for future research.
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The Roles of Implicit Memory Bias, Depression, and Metacognitions in Men and Women With Coronary Artery Disease.

Filed under: Depression Treatment

Am J Mens Health. 2012 Aug 8;
Khodarahimi S, Rasti A

The purpose of this research was to examine the role of implicit memory bias, depression, and metacognitions in coronary artery disease (CAD) and the relationships between implicit memory bias, depression, and metacognitions based on gender, age, and educational status. Participants were 30 patients with CAD and controls who were selected through a purposive sampling method in Iran. A demographic questionnaire, the Meta-Worry Questionnaire-30; the Beck’s Depression Inventory-II; and the Word Stem Completion Software were used in this study. Resulting data demonstrated that patients with CAD had significant higher levels of depression, metacognitive worry, and negative-mood-inducing words than individuals in the control group. Also, individuals in the control group had significant higher performance on neutral-mood-inducing words than patients with CAD. Depression and metacognitive variables were significantly related to negative- and neutral-mood-inducing words in the total sample. Findings did not support significant relationships of age and educational level to depression, metacognition, and the implicit memory bias in males and females.
HubMed – depression


Addressing methodological challenges in implementing the nursing home pain management algorithm randomized controlled trial.

Filed under: Depression Treatment

Clin Trials. 2012 Aug 9;
Ersek M, Polissar N, Du Pen A, Jablonski A, Herr K, Neradilek MB

BACKGROUND: Unrelieved pain among nursing home (NH) residents is a well-documented problem. Attempts have been made to enhance pain management for older adults, including those in NHs. Several evidence-based clinical guidelines have been published to assist providers in assessing and managing acute and chronic pain in older adults. Despite the proliferation and dissemination of these practice guidelines, research has shown that intensive systems-level implementation strategies are necessary to change clinical practice and patient outcomes within a health-care setting. One promising approach is the embedding of guidelines into explicit protocols and algorithms to enhance decision making. PURPOSE: The goal of the article is to describe several issues that arose in the design and conduct of a study that compared the effectiveness of pain management algorithms coupled with a comprehensive adoption program versus the effectiveness of education alone in improving evidence-based pain assessment and management practices, decreasing pain and depressive symptoms, and enhancing mobility among NH residents. METHODS: The study used a cluster-randomized controlled trial (RCT) design in which the individual NH was the unit of randomization. The Roger’s Diffusion of Innovations theory provided the framework for the intervention. Outcome measures were surrogate-reported usual pain, self-reported usual and worst pain, and self-reported pain-related interference with activities, depression, and mobility. RESULTS: The final sample consisted of 485 NH residents from 27 NHs. The investigators were able to use a staggered enrollment strategy to recruit and retain facilities. The adaptive randomization procedures were successful in balancing intervention and control sites on key NH characteristics. Several strategies were successfully implemented to enhance the adoption of the algorithm. LIMITATIONS: /Lessons The investigators encountered several methodological challenges that were inherent to both the design and implementation of the study. The most problematic issue concerned the measurement of outcomes in persons with moderate to severe cognitive impairment. It was difficult to identify valid, reliable, and sensitive outcome measures that could be applied to all NH residents regardless of the ability to self-report. Another challenge was the inability to incorporate advances in implementation science into the ongoing study CONCLUSIONS: Methodological challenges are inevitable in the conduct of an RCT. The need to optimize internal validity by adhering to the study protocol is compromised by the emergent logistical issues that arise during the course of the study. Clinical Trials 2012; 0: 1 -11.
HubMed – depression


Yoga Reduces Depression in Pregnant Women, Boosts Maternal Bonding

Filed under: Depression Treatment

Researchers say that the study is the first to provide evidence that mindfulness yoga may be an effective alternative to pharmaceutical treatment for pregnant women showing signs of depression. The findings were published in Complementary Therapies in …
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Transcranial Stimulation Effective for Hard to Treat Depression

Filed under: Depression Treatment

A new clinical study finds that transcranial magnetic stimulation (TMS) is an effective treatment for patients with depression who are unable to find symptom relief through antidepressant medications. Researchers say that this is one of the first …


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