Can nonantidepressants help treat depression?

lithium, triiodothyronine (T3), and atypical antipsychotics are all effective adjuncts. Lithium (serum levels >0.5 mEq/L) can produce clinical improvement when added to ineffective antidepressant treatment (strength of recommendation [SOR]: A, meta-analysis of randomized controlled trials [RCTs]). Thyroid supplementation using T3 at doses no higher than 50 mcg per day also increases the effectiveness of antidepressant therapy (SOR: B, meta- analysis of RCT and cohort studies). Atypical antipsychotic agents are less effective adjuncts for patients with treatment-resistant major depressive disorder (SOR: B, meta-analysis of RCT and cohort studies)

What laboratory monitoring is appropriate to detect adverse drug reactions in patients on cholesterol-lowering agents?

Recommendations for measuring serum aminotransferase levels before initiating pharmacologic treatment for hypercholesterolemia, after 12 weeks of therapy, and periodically afterward are based on expert opinion. It is not recommended that serum creatine kinase (CK) levels be monitored for elevation indicative of myopathy during cholesterol-lowering therapy. (Grade of recommendation: D, based on expert opinion without explicit critical appraisal

What is the initial approach to the treatment of shoulder pain?

There is some limited evidence supporting the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in the initial treatment of shoulder pain. There is no evidence in support of most other therapies, including intra-articular or subacromial corticosteroid injection, intra-articular NSAID injection, oral corticosteroid treatment, physiotherapy, ultrasound, heat or ice therapy, laser treatment, electrotherapy, and iontophoresis (Grade of recommendation: B, based on extrapolation from systematic reviews and randomized clinical trials with inconsistent and inconclusive results

A polyhedral Frobenius theorem with applications to integer optimization

We prove a representation theorem of projections of sets of integer points by an integer matrix $W$. Our result can be seen as a polyhedral analogue of several classical and recent results related to the Frobenius problem. Our result is motivated by a large class of nonlinear integer optimization problems in variable dimension. Concretely, we aim to optimize $f(Wx)$ over a set $\mathcal{F} = P\cap \mathbb{Z}^n$, where $f$ is a nonlinear function, $P\subset \mathbb{R}^n$ is a polyhedron, and $W\in \mathbb{Z}^{d\times n}$. As a consequence of our representation theorem, we obtain a general efficient transformation from the latter class of problems to integer linear programming. Our bounds depend polynomially on various important parameters of the input data leading, among others, to first polynomial time algorithms for several classes of nonlinear optimization problems. Read More: http://epubs.siam.org/doi/10.1137/14M097369

"Now he walks and walks, as if he didn't have a home where he could eat": food, healing, and hunger in Quechua narratives of madness

In the Quechua-speaking peasant communities of southern Peru, mental disorder is understood less as individualized pathology and more as a disturbance in family and social relationships. For many Andeans, food and feeding are ontologically fundamental to such relationships. This paper uses data from interviews and participant observation in a rural province of Cuzco to explore the significance of food and hunger in local discussions of madness. Carers’ narratives, explanatory models, and theories of healing all draw heavily from idioms of food sharing and consumption in making sense of affliction, and these concepts structure understandings of madness that differ significantly from those assumed by formal mental health services. Greater awareness of the salience of these themes could strengthen the input of psychiatric and psychological care with this population and enhance knowledge of the alternative treatments that they use. Moreover, this case provides lessons for the global mental health movement on the importance of openness to the ways in which indigenous cultures may construct health, madness, and sociality. Such local meanings should be considered by mental health workers delivering services in order to provide care that can adjust to the alternative ontologies of sufferers and carers

Clinician perceptions of factors influencing referrals to a smoking cessation program

<p>Abstract</p> <p>Background</p> <p>Referral of patients to smoking cessation telephone counseling (i.e., quitline) is an underutilized resource by primary care physicians. Previously, we conducted a randomized trial to determine the effectiveness of benchmarked feedback on clinician referrals to a quitline. Subsequently, we sought to understand the successful practices used by the high-referring clinicians, and the perceptions of the barriers of referring patients to a quitline among both high and non-referring clinicians in the trial.</p> <p>Methods</p> <p>We conducted a qualitative sub-study with subjects from the randomized trial, comparing high- and non-referring clinicians. Structured interviews were conducted and two investigators employed a thematic analysis of the transcribed data. Themes and included categories were organized into a thematic framework to represent the main response sets.</p> <p>Results</p> <p>As compared to non-referring clinicians, high-referring clinicians more often reported use of the quitline as a primary source of referral, an appreciation of the quitline as an additional resource, reduced barriers to use of the quitline referral process, and a greater personal motivation related to tobacco cessation. Time and competing demands were critical barriers to initiating smoking cessation treatment with patients for all clinicians. Clinicians reported that having one referral source, a referral coordinator, and reimbursement for tobacco counseling (as a billable code) would aid referral.</p> <p>Conclusion</p> <p>Further research is needed to test the effectiveness of new approaches in improving the connection of patients with smoking cessation resources.</p> <p>Trial Registration Number</p> <p>Clinicaltrials.gov NCT00529256</p

A História da Alimentação: balizas historiográficas

Os M. pretenderam traçar um quadro da História da Alimentação, não como um novo ramo epistemológico da disciplina, mas como um campo em desenvolvimento de práticas e atividades especializadas, incluindo pesquisa, formação, publicações, associações, encontros acadêmicos, etc. Um breve relato das condições em que tal campo se assentou faz-se preceder de um panorama dos estudos de alimentação e temas correia tos, em geral, segundo cinco abardagens Ia biológica, a econômica, a social, a cultural e a filosófica!, assim como da identificação das contribuições mais relevantes da Antropologia, Arqueologia, Sociologia e Geografia. A fim de comentar a multiforme e volumosa bibliografia histórica, foi ela organizada segundo critérios morfológicos. A seguir, alguns tópicos importantes mereceram tratamento à parte: a fome, o alimento e o domínio religioso, as descobertas européias e a difusão mundial de alimentos, gosto e gastronomia. O artigo se encerra com um rápido balanço crítico da historiografia brasileira sobre o tema