The Posttraumatic Stress Disorder (PTSD) Checklist for DSM‐5 (PCL‐5) is a widely used, self‐report measure that is employed to assess PTSD symptom severity and determine the presence of probable PTSD ...in various trauma‐exposed populations. The PCL‐5 is often administered in clinical settings as a screening tool for PTSD, with a suggested cutoff score of 33 indicating a probable PTSD diagnosis. Recent research indicates that a higher cutoff may be required in psychiatric samples. In the present study, we aimed to determine the sensitivity and specificity of the PCL‐5 in a Canadian outpatient psychiatric sample and establish an optimal cutoff score for detecting probable PTSD in this sample. Participants were 673 individuals who reported a history of trauma exposure and were assessed using a semistructured interview and self‐report measures. Individuals diagnosed with PTSD (N = 193) reported a mean PCL‐5 score of 56.57, whereas individuals without PTSD (N = 480) reported a mean score of 33.56. A score of 45 was determined to be the optimal cutoff score in this sample, balancing sensitivity and specificity while detecting a probable diagnosis of PTSD. Consistent with findings in other psychiatric samples, these findings indicate that in an outpatient psychiatric sample with a history of exposure to a variety of trauma types, a higher cutoff score is required to determine probable PTSD. In addition, given the estimated rate of false positives even with a higher cutoff, follow‐up diagnostic assessments are recommended.
Despite considerable burden of cardiovascular disease (CVD), data on endometrial cancer survivors' CVD perceptions are lacking. We assessed survivors' perspectives on addressing CVD risk during ...oncology care.
This cross-sectional analysis utilized data from an ongoing trial of an EHR heart health tool (R01CA226078 & UG1CA189824) conducted through the NCI Community Oncology Research Program (NCORP, WF-1804CD). Endometrial cancer survivors post-potentially curative treatment were recruited from community practices and completed a pre-visit baseline survey, including American Heart Association Simple 7 CVD factors. Likert-type questions assessed confidence in understanding CVD risk, CVD risk perception, and desired discussion during oncology care. Medical record abstraction ascertained data on CVD and cancer characteristics.
Results: Survivors (N = 55, median age = 62; 62% 0–2 years post-diagnosis) were predominately white, non-Hispanic (87%). Most agreed/strongly agreed heart disease poses a risk to their health (87%) and oncology providers should talk to patients about heart health (76%). Few survivors reported smoking (12%) but many had poor/intermediate values for blood pressure (95%), body mass index (93%), fasting glucose/A1c (60%), diet (60%), exercise (47%) and total cholesterol (53%). 16% had not seen a PCP in the last year; these survivors were more likely to report financial hardship (22% vs 0%; p = 0.02). Most reported readiness to take steps to maintain or improve heart health (84%).
Discussions of CVD risk during routine oncology care are likely to be well received by endometrial cancer survivors. Strategies are needed to implement CVD risk assessment guidelines and to enhance communication and referrals with primary care.
Clinical Trials #: NCT03935282
•Few endometrial cancer survivors have >3 ideal cardiovascular metrics as defined by the AHA's Simple 7•Approximately 1 in 6 cancer survivors in our cohort had not seen a PCP or cardiologist within the past year•The majority of survivors acknowledge their risk of cardiovascular disease and wish to discuss it with their oncologist
Youth in the U.S. experience a high rate of assault-related injuries resulting in physical, psychological and social sequelae that require a wide range of services after discharge from the hospital. ...Hospital-based violence intervention programs (HVIP's) have been developed to engage youth in services designed to reduce the incidence of violent injury in young people. HVIP's combine the efforts of medical staff with community-based partners to provide trauma-informed care to violently-injured people and have been found to be a cost-effective means to reduce re-injury rates and improve social and behavioral health outcomes. Few studies have explored the organizational and community level factors that impact implementation of these important and complex interventions. The objective of this study was to develop an in-depth understanding of the factors that impact HVIP implementation from the perspectives of 41 stakeholders through qualitative interviews. Thematic analysis generated three themes that included the importance of integrated, collaborative care, the need for providers who can perform multiple service roles and deploy a range of skills, and the importance of engaging clients through extended contact. In this article we explore these themes and their implications for healthcare social work.
Coronary heart disease (CHD) is a leading cause of morbidity and mortality for breast cancer survivors, yet the joint effect of adverse cardiovascular health (CVH) and cardiotoxic cancer treatments ...on post-treatment CHD and death has not been quantified.
We conducted statistical and machine learning approaches to evaluate 10-year risk of these outcomes among 1934 women diagnosed with breast cancer during 2006 and 2007. Overall CVH scores were classified as poor, intermediate, or ideal for 5 factors, smoking, body mass index, blood pressure, glucose/hemoglobin A1c, and cholesterol from clinical data within 5 years prior to the breast cancer diagnosis. The receipt of potentially cardiotoxic breast cancer treatments was indicated if the patient received anthracyclines or hormone therapies. We modeled the outcomes of post-cancer diagnosis CHD and death, respectively.
Results of these approaches indicated that the joint effect of poor CVH and receipt of cardiotoxic treatments on CHD (75.9%) and death (39.5%) was significantly higher than their independent effects poor CVH (55.9%) and cardiotoxic treatments (43.6%) for CHD, and poor CVH (29.4%) and cardiotoxic treatments (35.8%) for death.
Better CVH appears to be protective against the development of CHD even among women who had received potentially cardiotoxic treatments. This study determined the extent to which attainment of ideal CVH is important not only for CHD and mortality outcomes among women diagnosed with breast cancer.
Post-Event Processing (PEP) is prevalent and problematic in Social Anxiety Disorder (SAD) but is typically not a direct target in evidence-based treatments such as cognitive behavioural therapy (CBT) ...for SAD. The primary aim of the current study was to examine the impact of several theoretically and empirically derived interventions for PEP in SAD, including concrete thinking, abstract thinking, and distraction in comparison to a control (i.e., do nothing) condition. Based on prior research, we hypothesized that the concrete and distract conditions would be associated with positive benefits, including reductions in PEP and improvements in self-perception, whereas the abstract and control conditions would not. The second aim of the study was to identify baseline variables that predict the trajectory of change in PEP over time. Participants (N=92) with a principal diagnosis of SAD completed a social stress task and were randomly assigned to one of four conditions. Participants completed measures at baseline, post-intervention/control, and at 1-week, and 1-month follow-up. Contrary to hypotheses, all three active conditions were similarly effective at reducing PEP and improving self-perceptions relative to the control condition. In the absence of an intervention, engagement in PEP remained high up to a month following the social stress task. Higher levels of baseline state anxiety, intolerance of uncertainty, and use of safety behaviours predicted greater PEP, even in the presence of an intervention. These results highlight the benefits of relatively brief interventions that disrupt the course of PEP for people with SAD. Such interventions can be easily incorporated into CBT protocols for SAD to enhance their effects.
•Without intervention, PEP remains elevated over prolonged periods of time.•PEP can be reduced with a number of brief interventions.•State anxiety, intolerance of uncertainty, and safety behaviour use predict PEP.•Positive metacognitive beliefs increase engagement in PEP over time.
The State-Trait Inventory for Cognitive and Somatic Anxiety (STICSA;
M. J. Ree, C. MacLeod, D. French, & V. Locke, 2000
) was designed to assess cognitive and somatic symptoms of anxiety as they ...pertain to one's mood in the moment (state) and in general (trait). This study extended the previous psychometric findings to a clinical sample and validated the STICSA against a well-published measure of anxiety, the State-Trait Anxiety Inventory (STAI;
C. D. Spielberger, 1983
). Patients (
N
= 567) at an anxiety disorders clinic were administered a battery of questionnaires. The results of confirmatory factor analyses (Bentler-Bonnett nonnormed fit index, comparative fit index, and Bollen fit index > .90; root-mean-square error of approximation < .05); convergent and discriminant validity analyses; and group comparisons supported the reliability and validity of the STICSA as a measure of state and trait cognitive and somatic anxiety. In addition, compared with the STAI (anxiety:
r
s ≤ .52; depression:
r
s ≥ .64), the STICSA was more strongly correlated with another measure of anxiety (
r
s ≥ .67) and was less strongly correlated with a measure of depression (
r
s ≤ .61). These findings suggest that the STICSA may be a purer measure of anxiety symptomatology than is the STAI.
Our study combined publicly available neighborhood socioeconomic status (nSES) data from the U.S. Census and clinical data to investigate the relationships between nSES, retention in care (RIC) and ...viral suppression (VS). Data from 2275 patients were extracted from 2009 to 2015 from a midwestern infectious diseases clinic. RIC was defined as patients who kept ≥ 3 visits and VS as an average viral load <200 copies/mL during their index year of study. Logistic regression models provided estimates for neighborhood-level and patient-level variables. In multivariable models, patients living in zip codes with low disability rates (1.50, 1.30-1.70), who wereolder (1.02, 1.01-1.03), and receiving antiretroviral therapy (ART; 3.81, 3.56-4.05) were more likely to have RIC, while those who were unemployed (0.72, 0.45-0.98) and self-reported as BIPOC (0.79, 0.64-0.97) were less likely to have RIC. None of the nSES variables were significantly associated with VS in multivariable models, yet older age (1.05, 1.04-1.05) and self-reported as BIPOC (1.68, 1.36-2.09) were modestly associated with VS, and receiving ART (6.14, 5.86-6.42) was a strong predictor of VS. In multivariable models, nSES variables were independently predictive more than of patient-level variables, for RIC but not VS.
Highlights • We examine emotional distress tolerance (EDT) across anxiety disorders. • We also assess its relationship to symptom severity and impairment. • Poor EDT is transdiagnostic but is not ...uniquely related to symptoms nor impairment. • Intolerance of uncertainty (IU) and anxiety sensitivity (AS) are better predictors. • IU and AS are more important to target in treating anxiety disorders than EDT.
•Emotion dysregulation in women during the perinatal period has not been examined.•Women improve in CBT for perinatal anxiety despite level of emotion dysregulation.•Perinatal high emotion ...dysregulation persists after CBT.•Perinatal emotion dysregulation may be a standalone factor that warrants treatment.
Emotion dysregulation (ED) has been implicated in anxiety disorders and may play an important role in Cognitive Behavioural Therapy (CBT) treatment for perinatal anxiety outcomes although there is a dearth of research in this area. The current study investigated the role of ED in perinatal anxiety treatment outcome to determine whether it impacts CBT treatment outcomes and whether CBT reduces ED.
Secondary analyses were run on a sample of N = 75 women participating in a CBT for perinatal anxiety randomized controlled trial (RCT), and N = 47 women who received the treatment as part of routine clinical care. Participants completed measures of anxiety, depression and ED at baseline, post-CBT/post-waitlist and 3-month follow-up (CBT-RCT group only). MANOVAs were conducted to determine if level of ED moderates treatment outcomes and whether CBT reduces ED. Reliable and clinically meaningful change was calculated.
Baseline level of ED did not moderate treatment outcomes. There were significant changes in some ED subscales over time in the CBT group compared to waitlist. Changes were reliable and clinically meaningful in 28.6% (RCT) and 16% (routine clinical care) of participants. Participants with high ED at baseline remained in the high range at post-treatment.
Limitations include low sample size; homogeneity of sample, use of measures not validated in perinatal populations.
These findings suggest that ED during the perinatal period may be a stand-alone factor that will need to be separately addressed in psychological treatment.
Current management of children with minor head trauma (MHT) and intracranial injuries is not evidence-based and may place some children at risk of harm. Evidence-based electronic clinical decision ...support (CDS) for management of these children may improve patient safety and decrease resource use. To guide these efforts, we evaluated the sociotechnical environment impacting the implementation of electronic CDS, including workflow and communication, institutional culture, and hardware and software infrastructure, among other factors.
Between March and May, 2020 semi-structured qualitative focus group interviews were conducted to identify sociotechnical influences on CDS implementation. Physicians from neurosurgery, emergency medicine, critical care, and pediatric general surgery were included, along with information technology specialists. Participants were recruited from nine health centers in the United States. Focus group transcripts were coded and analyzed using thematic analysis. The final themes were then cross-referenced with previously defined sociotechnical dimensions.
We included 28 physicians and four information technology specialists in seven focus groups (median five participants per group). Five physicians were trainees and 10 had administrative leadership positions. Through inductive thematic analysis, we identified five primary themes: (1) clinical impact; (2) stakeholders and users; (3) tool content; (4) clinical practice integration; and (5) post-implementation evaluation measures. Participants generally supported using CDS to determine an appropriate level-of-care for these children. However, some had mixed feelings regarding how the tool could best be used by different specialties (e.g. use by neurosurgeons versus non-neurosurgeons). Feedback from the interviews helped refine the tool content and also highlighted potential technical and workflow barriers to address prior to implementation.
We identified key factors impacting the implementation of electronic CDS for children with MHT and intracranial injuries. These results have informed our implementation strategy and may also serve as a template for future efforts to implement health information technology in a multidisciplinary, emergency setting.
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