Sugammadex and blood loss during cervical spine fusion surgery.

Background and Aims: Sugammadex (SUG) has been associated with changes in coagulation studies. Most reports have concluded a lack of clinical significance based on surgical blood loss with SUG use at the end of surgery. Previous reports have not measured its use intraoperatively during ongoing blood loss. Our hypothesis was that the use of SUG intraoperatively may increase bleeding. Material and Methods: This was a single site retrospective study. Inclusion criteria were patients undergoing a primary posterior cervical spine fusion, aged over 18 years, between July 2015 and June 2021. The primary outcomes compared were intraoperative estimated blood loss (EBL) and postoperative drain output (PDO) between patients receiving SUG, neostigmine (NEO) and no NMB reversal agent. The objective was to determine if there was a difference in primary endpoints between patients administered SUG, NEO or no paralytic reversal agent. Primary endpoints were compared using analysis of variance with a P value of 0.05 used to determine statistical significance. Groups were compared using the Chi-squared test, rank sum or student's t test. A logistic regression model was constructed to account for differences between the groups. Results: There was no difference in median EBL or PDO between groups. The use of SUG was not associated with an increase in odds for >500 milliliters (ml) of EBL. Increasing duration of surgery and chronic kidney disease were both associated with an increased risk for EBL >500 ml. Conclusion: Intraoperative use of SUG was not associated with increased bleeding. Any coagulation laboratory abnormalities previously noted did not appear to have an associated clinical significance.

Remote Patient Monitoring for Hypertension: Feasibility and Outcomes of a Clinic-Based Pilot in a Minority Population.

BACKGROUND: In the US 48% of adults have hypertension, with direct costs in excess of $130 billion per year. Remote patient monitoring (RPM) has been discussed as a useful tool in the treatment of hypertension, but few studies evaluate its cost effectiveness or efficacy in minority, lower socio-economic (SES) populations. Our study aims to evaluate the clinical and financial outcomes of RPM in hypertension management in a primarily minority, low-SES population. METHODS: In this prospective cohort pilot study, patients with uncontrolled primary hypertension (defined via Joint National Committee 8 guidelines) were randomly selected from a single academically affiliated primary care clinic. Patients were enrolled on a rolling basis for 90 days. Patients were given blood pressure cuffs and transmission hubs and asked to transmit daily blood pressure readings. Patients were called weekly by research assistants and concerns were escalated to the primary care physician. The control group was the remaining 299 uncontrolled hypertensive patients from the same clinic population analyzed via retrospective chart records at the conclusion of the interventional study period. The primary outcome was blood pressure control. Secondary outcomes were relative improvement in systolic pressure and direct costs. RESULTS: A total of 13 patients were enrolled into the RPM intervention; these patients were 54% female, 100% African American, and 77% Medicaid. When assessed via intention-to-treat analysis, patients in the intervention group had non-inferior blood pressure control at 90 days (46% experimental vs 31% control, P = .33) and average change in systolic blood pressure at 90 days (13.5 vs 3.7 mmHg, P = .174) while experiencing a significant reduction in office-based visits at 90 days (1.5 vs 5.9, P < .001) as compared to control. Results on per-protocol analysis also showed non-inferior BP control (63% vs 31%, P = .135). Financially, the program generated margins of $29 per patient at 90 days. CONCLUSIONS: Patients in our minority- and Medicaid-predominant cohort achieved noninferior blood pressure control as compared to retrospective control at 90 days and a significant reduction in all-cause clinic visits at 90 days. The program generated little revenue per patient, with main barriers to implementation including patient compliance and payor denial.

Generative Artificial Intelligence Terminology: A Primer for Clinicians and Medical Researchers.

Generative artificial intelligence (AI) is rapidly transforming the medical field, as advanced tools powered by large language models (LLMs) make their way into clinical practice, research, and education. Chatbots, which can generate human-like responses, have gained attention for their potential applications. Therefore, familiarity with LLMs and other promising generative AI tools is crucial to harness their potential safely and effectively. As these AI-based technologies continue to evolve, medical professionals must develop a strong understanding of AI terminologies and concepts, particularly generative AI, to effectively tackle real-world challenges and create solutions. This knowledge will enable healthcare professionals to utilize AI-driven innovations for improved patient care and increased productivity in the future. In this brief technical report, we explore 20 of the most relevant terminology associated with the underlying technology behind LLMs and generative AI as they relate to the medical field and provide some examples of how these topics relate to healthcare applications to help in their understanding.

An investigation of outcome expectancies as a predictor of treatment response for combat veterans with PTSD: comparison of clinician, self-report, and biological measures.

BACKGROUND: Outcome expectancy, or the degree to which a client believes that therapy will result in improvement, is related to improved treatment outcomes for multiple disorders. There is a paucity of research investigating this relation in regards to posttraumatic stress disorder (PTSD). Additionally, the bulk of the research on outcome expectancy and treatment outcomes has relied mostly on self-report outcome measures. METHODS: The relation between outcome expectancy on self-report measures, clinician-rated measures, and two biological indices (fear-potentiated startle and cortisol reactivity) of PTSD symptoms was explored. The sample included combat veterans (N = 116) treated with virtual reality exposure therapy for PTSD. RESULTS: Results supported a negative association between outcome expectancy and both self-report and clinician-rated symptoms at the conclusion of treatment, but outcome expectancy was related to the magnitude of change during treatment for self-report measures only. Outcome expectancy was unrelated to biological measures of treatment response. CONCLUSIONS: These findings suggest that outcome expectancy may be related to patient and clinician perceptions of outcomes, but not biological indices of outcome for PTSD.

Pilot trial of dialectical behavior therapy-enhanced habit reversal for trichotillomania.

BACKGROUND: Not all hair pullers improve acutely with cognitive-behavioral treatment (CBT) and few maintain their gains over time. METHODS: We conducted an open clinical trial of a new treatment that addresses affectively triggered pulling and emphasizes relapse prevention in addition to standard CBT approaches. Ten female participants satisfying DSM-IV criteria for trichotillomania (TTM) at two study sites received Dialectical Behavior Therapy (DBT)-enhanced CBT consisting of 11 weekly sessions and 4 maintenance sessions over the following 3 months. Independent assessors rated hair pulling impairment and global improvement at several study time points. Participants completed self-report measures of hair pulling severity and emotion regulation. RESULTS: Significant improvement in hair pulling severity and emotion regulation, as well as hair pulling impairment and anxiety and depressive symptoms, occurred during acute treatment and were maintained during the subsequent 3 months. Significant correlations were reported between changes in emotion regulation and hair pulling severity during both the acute treatment and maintenance phases. CONCLUSIONS: This study offers preliminary evidence for the efficacy of DBT-enhanced CBT for TTM and suggests the importance of addressing emotion regulation during TTM treatment.

Virtual reality exposure therapy using a virtual Iraq: case report.

Posttraumatic stress disorder (PTSD) has been estimated to affect up to 18% of returning Operation Iraqi Freedom (OIF) veterans. Soldiers need to maintain constant vigilance to deal with unpredictable threats, and an unprecedented number of soldiers are surviving serious wounds. These risk factors are significant for development of PTSD; therefore, early and efficient intervention options must be identified and presented in a form acceptable to military personnel. This case report presents the results of treatment utilizing virtual reality exposure (VRE) therapy (virtual Iraq) to treat an OIF veteran with PTSD. Following brief VRE treatment, the veteran demonstrated improvement in PTSD symptoms as indicated by clinically and statistically significant changes in scores on the Clinician Administered PTSD Scale (CAPS; Blake et al., 1990) and the PTSD Symptom Scale Self-Report (PSS-SR; Foa, Riggs, Dancu, & Rothbaum, 1993). These results indicate preliminary promise for this treatment.

A pilot study of an exposure-based intervention in the ED designed to prevent posttraumatic stress disorder.

Early interventions to prevent PTSD have been limited in scope and effectiveness. This pilot study examines the feasibility and preliminary effectiveness of a model for brief preventive intervention: 1-session individualized exposure-based therapy delivered in the emergency department (ED). Eligible patients who experienced exposure to a traumatic event in the previous 24 hours were screened and assigned to assessment-only (n = 5) or intervention (imaginal exposure, n = 5) conditions. Both groups returned for 1-week follow-up. Results indicate that patients receiving this intervention reported slightly decreased levels of depression at 1-week follow-up and were rated lower on clinician-rated global severity of symptoms than patients in the assessment-only condition. The level of subject participation and ED staff support in this pilot study argues for feasibility of data collection, intervention, and follow-up with this population. Results also offer evidence that the intervention did not appear to harm participants and in fact may be helpful.

Placebo-controlled trial of risperidone augmentation for selective serotonin reuptake inhibitor-resistant civilian posttraumatic stress disorder.

OBJECTIVE: Treatment of posttraumatic stress disorder (PTSD) with pharmacotherapy is promising, although the response to medication has generally been modest, and strategies to improve the response to antidepressant medications are needed. The primary objective of this study was to examine risperidone augmentation in civilians with PTSD currently receiving sertraline without an optimal response. METHOD: Male and female participants aged 18 to 65 years were recruited from 3 academic medical centers between June 2004 and September 2006. Those who met eligibility criteria with a DSM-IV diagnosis of PTSD subsequent to a civilian trauma and a Clinician-Administered PTSD Scale (CAPS) score greater than or equal to 50 at screen and baseline were entered into phase 1. In phase 1, patients were treated for 8 weeks with open-label sertraline. Those who did not remit (defined as a 70% decrease in PTSD symptoms as measured by the CAPS) were entered into phase 2. In phase 2, patients remained on sertraline and were randomly assigned to augmentation with risperidone or matching pill placebo for 8 weeks. Symptoms of PTSD and depression and psychotic symptoms were measured prospectively throughout the 16-week study. RESULTS: Of the 45 patients enrolled, 34 completed phase 1, and 25 of those patients were randomly assigned to phase 2; 20 completed phase 2. For all patients across all phases, PTSD and related symptoms improved with no significant differences between groups. In post hoc analyses, the group that received risperidone augmentation had significantly more improvement than the placebo group on the Davidson Trauma Scale (DTS) sleep item (p = .03) and demonstrated a trend toward significantly more improvement on the Clinical Global Impressions-Improvement scale (p = .066), the positive (p = .065) and paranoia (p = .1) subscales of the Positive and Negative Syndrome Scale, and the CAPS sleep item (p = .09). CONCLUSION: Participants responded well to sertraline in phase 1, sustained their response, and displayed a placebo response comparable with that of risperidone in phase 2. There is some evidence to support the conclusion that risperidone augmentation was helpful in those subjects who did not remit with sertraline alone, particularly in the areas of global improvement, positive affect, and sleep. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00133822.