Integrated care increases the proportion of patients with HCV infection and psychiatric illness and/or substance abuse who begin antiviral therapy and achieve SVRs, without serious adverse events. ClinicalTrials.gov # NCT00722423.
Background We now know that nurses are at greater risk for suicide than others in the general population. It is known that job stressors are prevalent in nurses who die by suicide. Yet, little is known about targeted suicide prevention for nurses. The first nurse‐centric Healer Education Assessment and Referral (HEAR) suicide prevention program was piloted for 6 months in 2016. The HEAR program was effective in identifying at‐risk nurses. Aim The purpose of this paper is to report the 3‐year sustainability and outcomes of this nurse suicide prevention program. Methods Descriptive statistics are provided of program outcomes over the course of 3 years. Results Over the 3 years, 527 nurses have taken advantage of the screening portion of the program. Of these, 254 (48%) were Tier 1 high risk, and 270 (51.2%) were Tier 2 moderate risk. A startling 48 (9%) had expressed thoughts of taking their own life, 51 (9.7%) had a previous suicide attempt, whereas only 79 (15%) were receiving counseling or therapy. One hundred seventy‐six nurses received support from therapists electronically, over the phone, or in person; 98 nurses accepted referral for treatment. The number of group emotional debriefs rose from eight in 2016 to 15 in 2017 to 38 in fiscal year 2019. Many of the debriefs are now requested (vs. offered), demonstrating the development of a culture open to reaching out for mental health treatment. Linking Evidence to Action The initial success of this pilot program has been sustained. A nurse suicide prevention program of education, assessment, and referral is feasible, well‐received, proactively identifies nurses with reported suicidality and facilitates referral for care. The HEAR program has provided service to physicians and residents for 10 years and now supports effectiveness in nurses. The HEAR program is portable and ready for replication at other institutions.
Background In comparison with the general population, physicians, and physicians‐in‐training are at greater risk for suicide. Although key gender differences in suicide risk factors and behaviors have been identified in the general population, the extent to which these differences apply to physicians and physicians‐in‐training is unclear. Here, we aimed to identify gender differences in risk factors, clinical presentation, and help‐seeking behaviors of medical students, house staff, and physician faculty at high risk for suicide. Methods We explored gender differences among 450 physicians and trainees meeting criteria for high suicide risk on anonymous online questionnaires completed between 2009 and 2017. Results High‐risk female trainees and physicians had higher mean Patient Health Questionnaire‐9 (PHQ‐9) scores compared with the males (11.1, standard deviation [SD] 5.1 vs. 9.8, SD 4.7) and were more likely to endorse feeling worried (73.8% vs. 61.2%), irritable (60.4% vs. 49.4%), and stressed (79.6% vs. 70%). High‐risk male trainees and physicians were more likely than females to endorse suicidal thoughts (31.2% vs. 22.1%), intense anger (24.3% vs. 16.1%), drinking too much (31.2% vs. 22.3%), and recreational drug or prescription medication use without clinically appropriate follow‐up (9.4% vs. 4.3%). There were no gender differences in help‐seeking behaviors. Conclusions This is the first study to report gender differences among risk factors, presentation, and help‐seeking behaviors of physicians, and trainees at high risk for suicide. Our findings are mostly consistent with those of the general population and show that only a minority of at‐risk men and women in healthcare sought treatment, highlighting the importance of intervention and suicide prevention in this population.
ABSTRACT. Objective: This article presents the fi rst direct comparison of level of response (LR)-based prospective models in two generations of the same families. To accomplish this, we describe results from the fi rst prospective evaluation of potential mediators of how an earlier low LR to alcohol relates to adverse alcohol outcomes in offspring from the San Diego Prospective Study (SDPS). Method: To compare with data from probands in the SDPS, new data were gathered from 86 drinking offspring (age ~20 years) during the 25-year follow-up of these families. Consistent with the usual effect of a low LR, outcomes 5 years later for both generations focused on drinking quantities as well as alcohol problems during the follow-up. A structural equation model (SEM) was used to analyze the relationships among variables, and the models in proband and offspring generations were compared using direct observations of the model results and through invariance procedures. Results: In these drinking offspring, LR correlated with 5-year outcomes (r = .48, p < .001) and the SEM R 2 was .48, with good fi t statistics. As predicted, the LR relationship to alcohol-related outcomes was both direct and partially mediated by heavier peer drinking, positive alcohol expectancies, and using alcohol to cope with stress. These results were similar to a previously published prospective model in SDPS probands, although path coeffi cients were generally higher in the younger group. Conclusions: The LR-based model of heavier drinking operated similarly across generations, with some modest differences. These results indicate that the model may be meaningful in both younger and middle-age groups. (J. Stud. Alcohol Drugs, 73, 195-204, 2012)
Introduction: Despite dramatic treatment advances , multiple myeloma (MM) remains a significant source of morbidity and mortality with 13,000 deaths expected annually in the United States. We characterized patterns of mortality, palliative care involvement, and disease course at the end of life for patients with MM over the last decade. Methods: We assessed all consecutive deceased patients with a diagnosis of MM who received health care at a single health care institution from January 2010 to December 2020. Institutional Review Board approval was obtained prior to data review. Descriptive statistics were employed, and chi square was used to compare categorical variables. Results: A total of 456 patients were identified. Patient characteristics and outcomes are listed in Table 1. In the year prior to death, the prevalence of depression was 45.8% (209 patients), whereas 75.4% of patients were on opiates as an outpatient (344 patients). The mean number of lines of treatment received from diagnosis to death was 3 (range 0-12). Two-hundred eleven (46.3%) patients required red blood cell transfusions in the year prior to death. Palliative care physicians saw 207 (45.4%) patients, of which 97 (46.9%) were seen as outpatient (including those who saw both outpatient and inpatient), and 110 (53.1%) exclusively as an inpatient. The median time from first palliative care consultation to death was 10 days for inpatient palliative care (range 0-389 days), and 107 days for outpatient palliative care (range 2-2028 days). Only 42 (9.2%) patients saw palliative care ≥6 months prior to death. Compared to those patients who did not see palliative care, those that saw palliative care ≥6 months prior to death were more likely to be female (61.9 versus 42.2%, p=0.05), younger (median age at diagnosis 66 versus 71, p=0.03), and have a longer survival (46 months versus 35 months, p=0.006) (Table 1 and Figure 1). Amongst the patients for whom place of death was clearly reported (351, 77%), 117 patients (33.3%) died in the acute care setting, 110 (31.3%) died in a hospice facility, and 124 (35.3%) died at home. Outpatient palliative care consultation did not correlate with a statistically significant difference in deaths in an acute care setting (22/81, 27.2% seeing outpatient palliative care versus 57/174, 32.8% for those who did not, p=0.36), or in chemotherapy (any active treatment other than just steroids) utilization in last month of life (30.9% versus 29.7%, p=0.83). Conclusion: In our analysis of the entire trajectory of the MM patient experience from diagnosis to death, we found a substantial proportion of patients with MM report depression, need opiates for pain control, require blood transfusions and are repeatedly hospitalized in the year prior to their death. A fifth of all deaths occur within a year of diagnosis. With a median of three lines of therapy from diagnosis to death, patients may not live to experience therapies reserved for later lines of treatment. A minority of these patients see a palliative care physician during their treatment journey with the median time from palliative care consultation to death only a month. Palliative care referral at this health system is physician-initiated and not based on standard criteria, which may impact these findings. While there is no clear correlation that palliative care consultation impacted the rate of acute care deaths or decreased utilization of MM treatment in the last month of life, (two common but complicated proxies for quality of end-of-life care), further prospective research on optimal utilization of specialist palliative care is required. Figure 1 Figure 1. Disclosures Sborov: GlaxoSmithKline: Consultancy; Janssen: Consultancy, Membership on an entity's Board of Directors or advisory committees; SkylineDx: Consultancy; Sanofi: Consultancy.
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