Objectifying Acupuncture Effects by Lung Function and Numeric Rating Scale in Patients Undergoing Heart Surgery.

Objectifying acupuncture effects by lung function and numeric rating scale in patients undergoing heart surgery.

Evid Based Complement Alternat Med. 2013; 2013: 219817
Maimer A, Remppis A, Sack FU, Ringes-Lichtenberg S, Greten T, Brazkiewicz F, Schröder S, Goncalves M, Efferth T, Greten HJ

Rationale. Poststernotomy pain and impaired breathing are common clinical problems in early postoperative care following heart surgery. Insufficiently treated pain increases the risk of pulmonary complications. High-dose opioids are used for pain management, but they may cause side effects such as respiratory depression. Study Design. We performed a prospective, randomized, controlled, observer-blinded, three-armed clinical trial with 100 patients. Group 1 (n = 33) and Group 2 (n = 34) received one 20?min session of standardized acupuncture treatment with two different sets of acupoints. Group 3 (n = 33) served as standard analgesia control without additional intervention. Results. Primary endpoint analysis revealed a statistically significant analgesic effect for both acupuncture treatments. Group 1 showed a mean percentile pain reduction (PPR) of 18% (SD 19, P < 0.001). Group 2 yielded a mean PPR of 71% (SD 13, P < 0.001). In Group 1, acupuncture resulted in a mean forced vital capacity (FVC) increase of 30?cm(3) (SD 73) without statistical significance (P = 0.303). In Group 2, posttreatment FVC showed a significant increase of 306?cm(3) (SD 215, P < 0.001). Conclusion. Acupuncture revealed specific analgesic effects after sternotomy. Objective measurement of poststernotomy pain via lung function test was possible. HubMed – depression


Results From a Single-Blinded Randomized Study (APPROVAL) Comparing The Impact of Different Ablation Strategies on Long Term Procedure Outcome in Coexistent Atrial Fibrillation and Flutter.

Circulation. 2013 Apr 9;
Mohanty S, Mohanty P, Di Biase L, Bai R, Santangeli P, Casella M, Dello Russo A, Tondo C, Themistoclakis S, Raviele A, Rossillo A, Corrado A, Pelargonio G, Forleo G, Natale A

BACKGROUND: This study examined the impact of different ablation strategies on AF recurrence and quality of life (QoL) in coexistent atrial fibrillation (AF) and flutter (AFL). METHODS AND RESULTS: Three-hundred sixty enrolled patients with documented AF and AFL were blinded and randomized to group 1: AF±AFL ablation (n=182) or Group 2: AFL ablation only (n=178). AF-recurrence was evaluated with event-recording and 7-day Holter at 3, 6, 9 and 12 months follow-up. QoL was assessed at baseline and 12-month follow-up using 4 questionnaires; Medical Outcome Study Short Form, Hospital Anxiety and Depression Score, Beck Depression Inventory and State-Trait Anxiety Inventory. Of the 182 patients in group 1, 58 (63±8 years, 78% male, 59±8% LVEF) had AF+AFL ablation and 124 (61±11 years, 72% male, 59±7% LVEF) had AF ablation only. In group 2 (62±9 years, 76% male, 58±10% LVEF) only flutter was ablated by achieving bidirectional isthmus conduction block. Baseline characteristics were not different across groups. At 21±9 months follow-up, 125 (69%) in group 1 and 34 (19%) in group 2 were arrhythmia-free (p <0.001). In group 1, scores on most QoL subscales showed significant improvement at follow-up, whereas group 2 patients derived relatively minor benefit. CONCLUSIONS: In coexistent AF and AFL, lower recurrence rate and better QoL is associated with AF ablation only or AF +AFL ablation, than with lone AFL ablation. Furthermore, QoL directly correlates with freedom from arrhythmia as shown in this study for the first time, in patients blinded to the procedure. CLINICAL TRIAL REGISTRATION INFORMATION: http://clinicaltrial.gov/. Unique Identifier: NCT01439386. HubMed – depression


Depression Screening and Management Among Adolescents in Primary Care: Factors Associated With Best Practice.

Clin Pediatr (Phila). 2013 Apr 9;
Taliaferro LA, Hetler J, Edwall G, Wright C, Edwards AR, Borowsky IW

Objective. To compare depression identification and management perceptions and practices between professions and disciplines in primary care and examine factors that increase the likelihood of administering a standardized depression screening instrument, asking about patients’ depressive symptoms, and using best practice when managing depressed adolescents. Methods. Data came from an online survey of clinicians in Minnesota (20% response rate). Analyses involved bivariate tests and linear regressions. Results. The analytic sample comprised 260 family medicine physicians, 127 pediatricians, 96 family nurse practitioners, and 54 pediatric nurse practitioners. Overall, few differences emerged between physicians and nurse practitioners or family and pediatric clinicians regarding addressing depression among adolescents. Two factors associated with administering a standardized instrument included having clear protocols for follow-up after depression screening and feeling better prepared to address depression among adolescents. Conclusions. Enhancing clinicians’ competence to address depression and developing postscreening protocols could help providers implement universal screening in primary care. HubMed – depression


The Effect of Telephone-Facilitated Depression Care on Older, Medically Ill Patients.

J Behav Health Serv Res. 2013 Apr 10;
Pickett YR, Kennedy GJ, Freeman K, Cummings J, Woolis W

The objective of this study was to determine the effectiveness of a telephone-facilitated depression care protocol in older, medically ill adults compared to routine care. A 12-week double blind randomized controlled trial was conducted in recently discharged primary care patients (N?=?124). Depression was assessed with the Patient Health Questionnaire-9. Primary care providers were notified of the level of depression severity and indications for treatment, but neither they nor the patients were contacted by a psychiatrist or other mental health professional. The primary outcome was initiation of treatment. Secondary outcomes were symptoms reduction and depression remission rates. There were no significant outcome differences between the facilitated and routine care groups. This study showed that older, medically ill adults may require a level of depression care that goes beyond a telephone-facilitated protocol. HubMed – depression



2012 Neidorf Memorial Lecture – The Effects of Ketamine on Dopamine and Depression – The 2012 Gloria Neidorf Memorial Lecture: The Effects of Ketamine on Dopamine and Depression with Pauline Belujon, Ph.D.,. Research Assistant Professor, Depa…