Strategic Use of Wellness Ambassadors to Increase Attendance of Initial Mental Health Appointments

Background Many adults and children with mental health conditions in the US do not receive treatment, and in Philadelphia alone, there were 174 suicide deaths in 2017. The shortage of mental health professionals and long wait times are significant barriers to accessing mental health care. Executive function difficulties can make it challenging for individuals to maintain a schedule for mental health appointments. A study found that reminder phone calls result in an increased rate of mental health appointment keeping. The goal of this project is to increase attendance of first mental health appointments by patients referred to mental health services via Wellness Ambassadors (WLA) in the family medicine office to help schedule initial appointments. Objectives \u3e75% participant attendance of mental health appointments scheduled with WLA assistance Investigate how sequelae of mental health disorders serve as a primary barrier to accessing mental health care. Collect pertinent data about the level of effort necessary to access the appropriate mental health care for each participant to influence future public health policy surrounding mental healthcare access. Proposal Overview Students enrolled in mental health programs volunteering to be Wellness Ambassadors will be trained in case management and telephonic follow-up interventions to help schedule an appointment with mental health services that is practical based on the patient’s timeline and resources in accordance with the services referred by their PCP. Phase 1 will take place in the PCOM family medicine office. There, volunteers will schedule initial appointments with mental health providers for qualifying participants before they leave the office. Phase 2 will be dedicated to scaling up to offer this service at up to four additional family medicine clinics on top of continuing at the PCOM family medicine clinic. WLAs will complete the Citi training and PCOM institutional training for research that involves human participants as well as HIPAA compliance certification. All volunteers will receive communication training to ensure that participants understand the services and their right to discontinue at any time. Evaluation of Outcomes After both phase 1 and 2, an anonymous survey will be sent via Red Cap, PCOM’s secure HIPAA-compliant platform, to all health care consumers at PCOM family medicine who provide their consent to participate. Anticipated Outcomes Majority of relevant survey respondents who enroll in the study will express that scheduling a mental health appointment without assistance would result in delay of care or losing access to care. Those who do not participate will indicate that receiving assistance to schedule their appointment would positively impact their ability to obtain and attend said appointment. More than 50% of participants will report being “unlikely” or “very unlikely” to schedule their first mental health appointment without assistance. Participants are expected to be 25% more likely to obtain mental health care services than non-participants. Preliminary data obtained will be used for further research into the impact of mental health disorders as a barrier to accessing mental health care

Ligelizumab for Chronic Spontaneous Urticaria

Background: In the majority of patients with chronic spontaneous urticaria, most currently available therapies do not result in complete symptom control. Ligelizumab is a next-generation high-affinity humanized monoclonal anti-IgE antibody. Data are limited regarding the dose–response relationship of ligelizumab and the efficacy and safety of ligelizumab as compared with omalizumab and placebo in patients who have moderate-to-severe chronic spontaneous urticaria that is inadequately controlled with H1-antihistamines at approved or increased doses, alone or in combination with H2-antihistamines or leukotriene-receptor antagonists. Methods: In a phase 2b dose-finding trial, we randomly assigned patients to receive ligelizumab at a dose of 24 mg, 72 mg, or 240 mg, omalizumab at a dose of 300 mg, or placebo, administered subcutaneously every 4 weeks for a period of 20 weeks, or a single 120-mg dose of ligelizumab. Disease symptoms of hives, itch, and angioedema were monitored by means of weekly activity scores. The main objective was to determine a dose–response relationship for the complete control of hives (indicated by a weekly hives-severity score of 0, on a scale from 0 to 21, with higher scores indicating greater severity); the primary end point of this response was assessed at week 12. Complete symptom control was indicated by a weekly urticaria activity score of 0 (on a scale from 0 to 42, with higher scores indicating greater severity). Safety was analyzed throughout the trial. Results: A total of 382 patients underwent randomization. At week 12, a total of 30%, 51%, and 42% of the patients treated with 24 mg, 72 mg, and 240 mg, respectively, of ligelizumab had complete control of hives, as compared with 26% of the patients in the omalizumab group and no patients in the placebo group. A dose–response relationship was established. At week 12, a total of 30%, 44%, and 40% of the patients treated with 24 mg, 72 mg, and 240 mg, respectively, of ligelizumab had complete control of symptoms, as compared with 26% of the patients in the omalizumab group and no patients in the placebo group. In this small and short trial, no safety concerns regarding ligelizumab or omalizumab emerged. Conclusions: A higher percentage of patients had complete control of symptoms of chronic spontaneous urticaria with ligelizumab therapy of 72 mg or 240 mg than with omalizumab or placebo. (Funded by Novartis Pharma; ClinicalTrials.gov number, NCT02477332. opens in new tab.

The international EAACI/GA(2)LEN/EuroGuiDerm/APAAACI guideline for the definition, classification, diagnosis, and management of urticaria

Publisher Copyright: © 2021 GA²LEN. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.This update and revision of the international guideline for urticaria was developed following the methods recommended by Cochrane and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group. It is a joint initiative of the Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), the Global Allergy and Asthma European Network (GA(2)LEN) and its Urticaria and Angioedema Centers of Reference and Excellence (UCAREs and ACAREs), the European Dermatology Forum (EDF; EuroGuiDerm), and the Asia Pacific Association of Allergy, Asthma and Clinical Immunology with the participation of 64 delegates of 50 national and international societies and from 31 countries. The consensus conference was held on 3 December 2020. This guideline was acknowledged and accepted by the European Union of Medical Specialists (UEMS). Urticaria is a frequent, mast cell-driven disease that presents with wheals, angioedema, or both. The lifetime prevalence for acute urticaria is approximately 20%. Chronic spontaneous or inducible urticaria is disabling, impairs quality of life, and affects performance at work and school. This updated version of the international guideline for urticaria covers the definition and classification of urticaria and outlines expert-guided and evidence-based diagnostic and therapeutic approaches for the different subtypes of urticaria.Peer reviewe

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Separation Anxiety

Separation anxiety disorder (SAD) is one of the most common childhood anxiety disorders. SAD refers to an exaggeration of otherwise developmentally normal anxiety manifested by excessive concern, worry, and even dread of the real or anticipated separation from an attachment figure. Although separation anxiety is a developmentally appropriate phenomenon, the disorder manifests with inappropriate intensity or the inappropriateness of age and context. Although The Diagnostic and Statistical Manual of Mental Disorders, Edition 4 (DSM-IV) had limited the diagnosis of SAD to children and adolescents, the diagnosis has been extended to include SAD first diagnosed in adulthood in the 5th edition (DSM-V). SAD has serious implications for quality of life and functioning across several areas of life, including work, social interactions, and close relationships. SAD has been described as a gateway anxiety disorder that can lead to a variety of poor mental and physical health outcomes, including excessive worry, sleep issues, excessive distress in social settings, poor academic performance, and somatic complaints. Despite its prevalence, SAD is often underdiagnosed and undertreated. One of the marked differences in children diagnosed with separation anxiety compared to adults is the type of attachment figures involved. In the case of children, the attachment figures are usually adults, such as parents. Adults, in contrast, experience anxiety when experiencing real or anticipated separation from children, spouses, or romantic partners

Supplements, Diets and Other Complementary and Alternative Interventions in Adolescent Mental Health

Background: Complementary and alternative medicine (CAM) has become increasingly popular over the past 20 years and is used by many adolescents and their families. CAM includes a host of integrative approaches whose difference from traditional medicine center around its holistic rather than compartmentalized approach to the patient, in which evaluation of health and well-being considers the mind, body, and spirit. Methods: This article provides an overview of both pharmacologic and non-pharmacologic approaches, with a focus on 1) how CAM can be used in clinical practice; 2) how to best choose amongst available approaches guided by research findings that provide information to maximize safety and efficacy. Two hypothetical cases illustrate how to apply the research base of evidence to patients and thus avoid diagnostic pitfalls and safety concerns. Results: Current research points to the efficacy of CAM in adult and adolescent populations and the efficacy of interventions that include attention to good nutrition, regular exercise, sunlight, and hygiene, especially as these interventions may prevent or reduce the incidence of conduct disorder. Recent studies suggest that CAM treatments can improve overall functioning and reduce difficulties such as insomnia, depression and aggression that occur due to anxiety, attentional deficits, and mood disorders. Conclusions: It is important to acknowledge the current public perception that CAM treatments are less likely to cause serious adverse effects as compared to conventional treatments. More studies of adolescent populations critical to confirm which complementary and alternative medicine treatments are both safe and efficacious. An informed open-minded attitude to non-conventional approaches has the potential to improve outcomes and trust amongst parents, adolescents and mainstream medical and behavioral health staff