An Assessment Of The Utilization Of Geriatric Depression Screenings In Primary Care Providers

The purpose of this study was to determine the practices of primary care providers in relation to screening and treating geriatric depression. According to the Geriatric Mental Health Foundation (GMHF), depression and suicide are significant public health issues for older adults, noting that depression is one of the most common mental disorders experienced by elders. Research indicates the issue of geriatric depression is poorly approached by providers and patients do not receive appropriate care. Depression cannot be measured with lab or diagnostic tests; the only way to assess depression is to screen patients by asking questions. When screening for depression, understanding that follow-up with treatment is equally as important as the diagnosis is imperative. Currently, the United States Preventative Services Task Force (USPSTF) has very narrow guidelines that recommend screening for depression in the general adult population, with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up. Permission to conduct the study was initially obtained from the Institutional Review Board at Mississippi University for Women. Providers were asked to complete a multi-question survey created by the researchers, indicating current depression screening practices, which was available on both Survey Monkey and on paper. Upon obtaining 100 surveys, 99 were included in data analysis and 97% of respondents identified as a nurse practitioner. Upon analysis of the statistical data, the research questions were reviewed and are as follows: 1) Do primary care providers perform depression screening on geriatric patients? 2) What barriers exist to performing depression screening on geriatric patients? 3) If geriatric patients are identified as at risk for depression, what interventions are being utilized by primary care providers to address this issue? The data indicated 40% of the surveyed providers reported screening every geriatric patient for depression, but the vast majority do not automatically screen geriatric patients for depression. Data also indicated barriers to screening every geriatric patient for depression included time constraints, patient declination, the screening being deemed unnecessary, or lack of reimbursement. Approximately one-third of providers admitted to not having time to screen patients for depression. Fifteen percent of providers identified the patient declining being screened as a barrier. Twelve percent of providers felt the screening was unnecessary, and researchers were unsure of the criteria utilized by the provider to deem depression screening unnecessary. The researchers determined in the third question what interventions were implemented by providers upon the patients having a score indicative of depression. The options available were medication(s), psychiatry, therapy, or multiple combinations of the three options. The research indicated no statistically significant pattern of treatment is being followed by providers, although medication alone or with other options was used by a majority of respondents. The researchers determined primary care practitioners are not adequately screening and treating geriatric depression

Rehabilitation Therapy in Older Acute Heart Failure Patients (REHAB-HF) trial: Design and rationale.

BACKGROUND: Acute decompensated heart failure (ADHF) is a leading cause of hospitalization in older persons in the United States. Reduced physical function and frailty are major determinants of adverse outcomes in older patients with hospitalized ADHF. However, these are not addressed by current heart failure (HF) management strategies and there has been little study of exercise training in older, frail HF patients with recent ADHF. HYPOTHESIS: Targeting physical frailty with a multi-domain structured physical rehabilitation intervention will improve physical function and reduce adverse outcomes among older patients experiencing a HF hospitalization. STUDY DESIGN: REHAB-HF is a multi-center clinical trial in which 360 patients ≥60 years hospitalized with ADHF will be randomized either to a novel 12-week multi-domain physical rehabilitation intervention or to attention control. The goal of the intervention is to improve balance, mobility, strength and endurance utilizing reproducible, targeted exercises administered by a multi-disciplinary team with specific milestones for progression. The primary study aim is to assess the efficacy of the REHAB-HF intervention on physical function measured by total Short Physical Performance Battery score. The secondary outcome is 6-month all-cause rehospitalization. Additional outcome measures include quality of life and costs. CONCLUSIONS: REHAB-HF is the first randomized trial of a physical function intervention in older patients with hospitalized ADHF designed to determine if addressing deficits in balance, mobility, strength and endurance improves physical function and reduces rehospitalizations. It will address key evidence gaps concerning the role of physical rehabilitation in the care of older patients, those with ADHF, frailty, and multiple comorbidities

Relationship of Race With Functional and Clinical Outcomes With the REHAB-HF Multidomain Physical Rehabilitation Intervention for Older Patients With Acute Heart Failure

Background The REHAB‐HF (Rehabilitation Therapy in Older Acute Heart Failure Patients) randomized trial demonstrated that a 3‐month transitional, tailored, progressive, multidomain physical rehabilitation intervention improves physical function, frailty, depression, and health‐related quality of life among older adults with acute decompensated heart failure. Whether there is differential intervention efficacy by race is unknown. Methods and Results In this prespecified analysis, differential intervention effects by race were explored at 3 months for physical function (Short Physical Performance Battery [primary outcome], 6‐Minute Walk Distance), cognition, depression, frailty, health‐related quality of life (Kansas City Cardiomyopathy Questionnaire, EuroQoL 5‐Dimension‐5‐Level Questionnaire) and at 6 months for hospitalizations and death. Significance level for interactions was P≤0.1. Participants (N=337, 97% of trial population) self‐identified in near equal proportions as either Black (48%) or White (52%). The Short Physical Performance Battery intervention effect size was large, with values of 1.3 (95% CI, 0.4–2.1; P=0.003]) and 1.6 (95% CI, 0.8–2.4; P\u3c0.001) in Black and White participants, respectively, and without significant interaction by race (P=0.56). Beneficial effects were also demonstrated in 6‐Minute Walk Distance, gait speed, and health‐related quality of life scores without significant interactions by race. There was an association between intervention and reduced all‐cause rehospitalizations in White participants (rate ratio, 0.73 [95% CI, 0.55–0.98]; P=0.034) that appears attenuated in Black participants (rate ratio, 1.06 [95% CI, 0.81–1.41]; P=0.66; interaction P=0.067). Conclusions The intervention produced similarly large improvements in physical function and health‐related quality of life in both older Black and White patients with acute decompensated heart failure. A future study powered to determine how the intervention impacts clinical events is required. REGISTRATION URL: https://www.clinicaltrials.gov. Identifier: NCT02196038

Exploring the Effects Service Dogs Have on Veterans with PTSD

Post-Traumatic Stress Disorder (PTSD) is a mental illness resulting from exposure to a traumatic event. Symptoms of PTSD vary, but those affected commonly experience nightmares, flashbacks, hypervigilance, and trouble sleeping; they may also avoid people or situations that trigger traumatic memories. It is estimated that PTSD affects about 10-30% of all United States veterans. Additionally, traditional treatment methods have an average dropout rate of 25% among military personnel. Inadequate PTSD symptom management may lead to depression, anxiety, suicidality, isolation, unstable relationships, and substance misuse. The purpose of this review is to examine the current research concerning the use of service dogs as a treatment option for the management of PTSD and its associated symptoms among veterans with PTSD. A database search was done using CINAHL, APA PsycInfo, and MEDLINE. Limited research has been done on the effects service dogs have on American veterans\u27 management of PTSD. A total of eight studies met all inclusion criteria and were analyzed as part of this literature review. The results of this review of the current literature suggest that psychiatric service dogs have a positive influence on the management of PTSD among veterans. The studies analyzed suggest that the acquisition of a service dog contributes to lower PTSD scores and sequelae among veterans

Growth Motivation Moderates a Self-Serving Attribution Bias in the Health Domain

Past research on the self-serving attribution bias has shown that people typically protect their self-worth by attributing shortcomings to external factors to avoid personal responsibility. Subsequent work suggests that this pattern is attenuated among individuals highly motivated to achieve personal growth. We attempted to conceptually replicate past research on this moderating effect in a novel context. After measuring personality variation in growth motivation, participants (N = 126 college students) were randomly provided feedback implying that they were less healthy than their peers (failure), healthier than their peers (success) or a no feedback control. We found that among participants receiving failure feedback, growth motivation negatively predicted the extent to which participants attributed health outcomes to luck. While the expected pattern of the self-serving attribution bias was implied at very low levels of growth motivation, failure caused high growth-motivation participants to believe that their health was less influenced by chance factors

CD8 T Cell Response Maturation Defined by Anentropic Specificity and Repertoire Depth Correlates with SIVΔnef-induced Protection

The live attenuated simian immunodeficiency virus (LASIV) vaccine SIVΔnef is one of the most effective vaccines in inducing protection against wild-type lentiviral challenge, yet little is known about the mechanisms underlying its remarkable protective efficacy. Here, we exploit deep sequencing technology and comprehensive CD8 T cell epitope mapping to deconstruct the CD8 T cell response, to identify the regions of immune pressure and viral escape, and to delineate the effect of epitope escape on the evolution of the CD8 T cell response in SIVΔnef-vaccinated animals. We demonstrate that the initial CD8 T cell response in the acute phase of SIVΔnef infection is mounted predominantly against more variable epitopes, followed by widespread sequence evolution and viral escape. Furthermore, we show that epitope escape expands the CD8 T cell repertoire that targets highly conserved epitopes, defined as anentropic specificity, and generates de novo responses to the escaped epitope variants during the vaccination period. These results correlate SIVΔnef-induced protection with expanded anentropic specificity and increased response depth. Importantly, these findings render SIVΔnef, long the gold standard in HIV/SIV vaccine research, as a proof-of-concept vaccine that highlights the significance of the twin principles of anentropic specificity and repertoire depth in successful vaccine design

Increased CD8 T cell repertoire depth during SIVΔnef vaccination.

<p>(A) FW9, an epitope mapped in animal 256–00, escaped the CD8 T cell response by mutating a histidine into a tyrosine (H831Y). The escape mutant was recognized at week 38 but not at week 5, when the original epitope was mapped. (B) The GY9 epitope was recognized at week 5 in animal 256–00 as well as week 38, while its escape variant K76R was recognized only at week 38. The third escape variant S77G was not recognized at either time point.</p

Major alleles expressed as determined by MHC I genotyping.

<p>Major alleles expressed as determined by MHC I genotyping.</p

Increased anentropic specificity of SIV-specific CD8 T cell responses between weeks 5 and 20 after SIVΔnef vaccination.

<p>The response conservation index, a measure of the CD8 T cell response weighted negatively for entropy, increases for every animal between weeks 5 and 20 (p = 0.0156). The response conservation index for an animal at a given time point is calculated as<math><mrow><mo>∑</mo><mrow><mi>i</mi><mo>=</mo><mn>0</mn></mrow><mi>n</mi><mrow><msub><mi>F</mi><mi>i</mi></msub></mrow><mo stretchy="false">(</mo><mn>1</mn><mo>−</mo><msub><mi>E</mi><mi>i</mi></msub><mo stretchy="false">)</mo></mrow></math>, where F is the frequency of each epitope-specific CD8 T cell response as a fraction of the total magnitude of the response, E is the entropy of the epitope, and n is the number of epitope-specific CD8 T cell responses.</p