Giving up on giving up : stories of people who were previously suicidal : a project based upon an independent investigation

This qualitative study explores the role of hope and spirituality in those lives of people who were previously suicidal. Eight formerly suicidal women were asked a series of questions regarding their suicidal ideation, their suicidal belief system, suicidal behavior, and their thoughts on the role of hope and spirituality in their lives. Participants\u27 answers revealed the strength these women have. Major findings suggest that hope and spirituality play a huge role in helping people through desperate times. Almost all but one of the participants said that hope gave them the inspiration to carry on. The one person who said she did not believe in hope said it was because it meant not living in the moment; she needed to be future oriented. All participants said they rely on some form of spirituality. They all reported that spirituality is what gives them strength to go on and keeps them from wanting to try and end their lives again. The findings did support the previous literature. There are implications for social work practice such as informing clinicians on what works with working with suicidal clients. Additionally, a strong rapport between the clinician and the client was instrumental in the eyes of the client

Bostonia

Founded in 1900, Bostonia magazine is Boston University's main alumni publication, which covers alumni and student life, as well as university activities, events, and programs

FourFold Asthma Study (FAST): a study protocol for a randomised controlled trial evaluating the clinical cost-effectiveness of temporarily quadrupling the dose of inhaled steroid to prevent asthma exacerbations

BACKGROUND: Asthma is one of the commonest chronic diseases in the UK. Acute exacerbations of asthma are unpredictable, disruptive and frightening. They cause considerable morbidity and account for a large component of the health service costs of asthma. The widespread use of an asthma self-management plan, designed to encourage disease monitoring and timely intervention, can reduce exacerbations and is, therefore, recommended for all patients with asthma. Unfortunately, the majority of patients are not provided with such a plan. There are a variety of reasons for this but uncertainty about what to include in the plan when asthma control is deteriorating, but before the need for orally administered corticosteroids, is a contributing factor. The aim of this trial is to determine whether an asthma self-management plan, which includes a temporary quadrupling of the dose of inhaled corticosteroid when asthma control starts to deteriorate, reduces asthma exacerbations requiring orally administered corticosteroids or unscheduled health care consultation for asthma. METHODS: A multicentre, pragmatic, randomised trial in adults aged over 16 years with a clinical diagnosis of asthma, treated with a licensed dose of inhaled corticosteroid and at least one exacerbation in the previous 12 months requiring treatment with systemic corticosteroids. Participants will be randomised to either a self-management plan, which includes a temporary (maximum of 14 days) fourfold increase in inhaled corticosteroid or the same plan without an increase in inhaled corticosteroid. Participants will be followed up at 6 and 12 months and will attend the clinic for an additional visit if their asthma control deteriorates. The primary outcome is time to first asthma exacerbation, defined as the need for systemic corticosteroids and/or unscheduled health care consultation for asthma. The estimated sample size is 1800 participants. DISCUSSION: The FAST trial is an independent study that has been prioritised and commissioned by the National Institute for Health Research (NIHR) in the United Kingdom. It will provide high-quality evidence to inform clinical decision-making on the role of an asthma self-management plan, which includes a temporary fourfold increase of inhaled corticosteroid, when asthma control starts to deteriorate. The first participant was randomised on 17th May 2013 and recruitment will close on 31 January 2016 with the last patient last visit taking place in January 2017. TRIAL REGISTRATION: ISRCTN: 15441965, registered on 25 April 2013

Bostonia

Founded in 1900, Bostonia magazine is Boston University's main alumni publication, which covers alumni and student life, as well as university activities, events, and programs

Evaluating the efficacy of an empowerment-based self-management consultant intervention: results of a two-year randomized controlled trial

Objectives: This study was conducted to determine if an empowerment-based Diabetes Self-Management Consultant (DSMC) intervention was more effective than a group receiving Mailed metabolic Assessments Only (MAO) in improving diabetes-related quality of life and blood glucose control. Methods: A two-year clinical trial, in which 310 patients with type 2 diabetes were randomized to the DSMC intervention or the MAO group. The DSMC met with the patient to review the baseline assessments, then discussed this review with the patient and the patient's physician. Subsequently patients received monthly telephone calls from the DSMC who used the empowerment approach to help patients identify self-management problems, consider options, set goals and make adjustments to their diabetes self-management plans. Results: The Diabetes Self-Management Consultant (DSMC) intervention resulted in improvements in diabetes related quality of life (PAID) p = 0.008, the diabetes empowerment scale (DES-SF) p = 0.024, A1C p = 0.016, perceived understanding of diabetes p = 0.001 and satisfaction with diabetes care p = 0.019 as compared to the MAO group. Conclusion: The DSMC the intervention resulted in a broad array of modest diabetes related improvements. A promising area for future research would be to test the efficacy of combining an empowerment-based DSMC intervention with case management using algorithm-based medication adjustments for higher risk patients

Evaluating the efficacy of rib-to-pelvis growth-friendly surgery for the treatment of non-ambulatory early-onset scoliosis myelomeningocele patients

INTRODUCTION: Early-onset scoliosis (EOS) is a well-known orthopaedic manifestation in patients with myelomeningocele. The rib-based growing system (RBGS) has been proposed as an alternative for these individuals because of the poor outcomes with traditional surgical techniques. We aimed to describe the effect of RBGS in patients with nonambulatory EOS myelomeningocele. METHODS: We retrospectively reviewed the Pediatric Spine Study Group Multicenter Database for all patients with nonambulatory EOS myelomeningocele treated with RBGS from 2004 to 2019. Demographics, surgical data, radiographic findings, and postoperative complications were obtained. The quality-of-life parameters were assessed postoperatively using the Early-onset Scoliosis Questionnaire-24. RESULTS: Thirty patients (18 women; 60%) were patients with nonambulatory EOS myelomeningocele treated with RBGS. The mean age at the initial surgery was 5.3 years. The thoracic (T1-T12) spine height showed a significant increase from initial surgery to the most recent follow-up (P \u3c 0.001). Spine (T1-S1) height was also significantly increased (P \u3c 0.001). The postoperative complication rate was 87%. The Early-onset Scoliosis Questionnaire-24 demonstrates significant improvements in the quality-of-life scores (P = 0.037). CONCLUSION: This study demonstrated that RBGS could improve the reported quality-of-life scores in patients with nonambulatory EOS myelomeningocele when assessed with an EOS-oriented tool. Moreover, we confirmed the ability of RBGS to hold or even correct spinal deformity

Driving characteristics of electric-powered wheelchair users: how far, fast, and often do people drive?

OBJECTIVES: To determine the driving characteristics of electric-powered wheelchair users during unrestricted community activities and to compare the activity levels among an active group and a group of regular users. DESIGN: Multisite engineering evaluation of electric-powered wheelchair driving activity during unrestricted community mobility. SETTING: Data were collected in the communities of Pittsburgh, PA, and the National Veterans Wheelchair Games (NVWG) in San Antonio, TX. PARTICIPANTS: Seventeen people participated, all of whom used electric-powered wheelchairs as their primary means of mobility. INTERVENTION: Each subject was asked standarized questions about self and wheelchair use. Data logger and sensor installed on wheelchair. Data downloaded from logger. MAIN OUTCOME MEASURES: Speed, distance traveled, and the time that each subject's personal wheelchair was being driven were recorded for 24hr/d over approximately 5 days for each subject by using a custom-built data logger. RESULTS: The NVWG group traveled faster than the Pittsburgh group, but this difference was only statistically significant on the first day. The NVWG group was more likely to travel longer than the Pittsburgh group with significant differences seen in day 4 (P = .03) and day 5 (P = .05). Total distance traveled during the 5-day period and average distance traveled per day were also significantly different between the groups (P = .02 for both 5-day distance and daily distance), with the NVWG group traveling longer (17,164 +/- 8708m) when compared with the Pittsburgh group (8335 +/- 7074m) over the 5-day period. Both distance traveled and speed increased during afternoon and evening hours. The maximum distance traveled by any subject for each hour across the 2 groups was used to create the theoretic maximum distance day, which resulted in 7970m of driving. CONCLUSION: Drivers of electric-powered wheelchairs are most active during the afternoon and evening hours. Over the 5-day period of this study, there was little variation in the speed or distance driven per day. The subjects participating in the NVWG were more active than their counterparts during a typical week at home. The maximum theoretic distance that a wheelchair user in our group would travel is less than 8km. The range of current electric-powered wheelchairs appears adequate, if not generous, for the subjects in our study

High-Density Lipoprotein-Mediated Cholesterol Efflux Capacity Is Improved by Treatment With Antiretroviral Therapy in Acute Human Immunodeficiency Virus Infection

Background: Individuals infected with human immunodeficiency virus (HIV) have decreased high-density lipoprotein (HDL)-cholesterol and increased cardiovascular disease (CVD). Reverse cholesterol transport from macrophages may be inhibited by HIV and contribute to increased CVD. Human studies have not investigated longitudinal effects of HIV and antiretroviral therapy (ART) on cholesterol efflux. Methods: Subjects with acute HIV infection were randomized to ART or not. Cholesterol efflux capacity was determined ex vivo after exposure of murine macrophages to apolipoprotein B-depleted patient sera obtained at baseline and after 12 weeks. Results: After 12 weeks, HIV RNA decreased most in subjects randomized to ART. Available data on cholesterol demonstrated that efflux capacity from Abca1+/+ macrophages was increased most by sera obtained from ART-treated subjects (20.5% ± 5.0% to 24.3 % ± 6.9%, baseline to 12 weeks, P = .007; ART group [n = 6] vs 18.0 % ± 3.9% to 19.1 % ± 2.9%, baseline to 12 weeks, P = .30; untreated group [n = 6] [P = .04 ART vs untreated group]). Change in HIV RNA was negatively associated with change in Abca1+/+ macrophage cholesterol efflux (r = − 0.62, P = .03), and this finding remained significant (P = .03) after controlling for changes in HDL-cholesterol, CD4+ cells, and markers of monocyte or macrophage activation. Conclusions: In subjects acutely infected with HIV, ATP-binding cassette transporter A1-mediated cholesterol efflux was stimulated to a greater degree over time by apolipoprotein B-depleted serum from subjects randomized to ART. The improvement in cholesterol efflux capacity is independently related to reduction in viral load