ABSTRACT
BACKGROUND: The review of collateral information is an essential component of patient care. Although this is standard practice, minimal research has been done to quantify collateral information collection and to understand how collateral information translates to clinical decision making. To address this, we developed and piloted a novel measure (the McLean Collateral Information and Clinical Actionability Scale [M-CICAS]) to evaluate the types and number of collateral sources viewed and the resulting actions made in a psychiatric setting. OBJECTIVE: This study aims to test the feasibility of the M-CICAS, validate this measure against clinician notes via medical records, and evaluate whether reviewing a higher volume of collateral sources is associated with more clinical actions taken. METHODS: For the M-CICAS, we developed a three-part instrument, focusing on measuring collateral sources reviewed, clinical actions taken, and shared decision making between the clinician and patient. To determine feasibility and preliminary validity, we piloted this measure among clinicians providing psychotherapy at McLean Hospital. These clinicians (n=7) completed the M-CICAS after individual clinical sessions with 89 distinct patient encounters. Scales were completed by clinicians only once for each patient during routine follow-up visits. After clinicians completed these scales, researchers conducted chart reviews by completing the M-CICAS using only the clinician's corresponding note from that session. For the analyses, we generated summary scores for the number of collateral sources and clinical actions for each encounter. We examined Pearson correlation coefficients to assess interrater reliability between clinicians and chart reviewers, and simple univariate regression modeling followed by multilevel mixed effects regression modeling to test the relationship between collateral information accessed and clinical actions taken. RESULTS: The study staff had high interrater reliability on the M-CICAS for the sources reviewed (r=0.98; P<.001) and actions taken (r=0.97; P<.001). Clinician and study staff ratings were moderately correlated and statistically significant on the M-CICAS summary scores for the sources viewed (r=0.24, P=.02 and r=0.25, P=.02, respectively). Univariate regression modeling with a two-tailed test demonstrated a significant association between collateral sources and clinical actions taken when clinicians completed the M-CICAS (ß=.27; t87=2.47; P=.02). The multilevel fixed slopes random intercepts model confirmed a significant association even when accounting for clinician differences (ß=.23; t57=2.13; P=.04). CONCLUSIONS: This pilot study established the feasibility and preliminary validity of the M-CICAS in assessing collateral sources and clinical decision making in psychiatry. This study also indicated that reviewing more collateral sources may lead to an increased number of clinical actions following a session.
ABSTRACT
Using an array-based approach after auditory fear conditioning and microRNA (miRNA) sponge-mediated inhibition, we identified a role for miR-34a within the basolateral amygdala (BLA) in fear memory consolidation. Luciferase assays and bioinformatics suggested the Notch pathway as a target of miR-34a. mRNA and protein levels of Notch receptors and ligands are downregulated in a time- and learning-specific manner after fear conditioning in the amygdala. Systemic and stereotaxic manipulations of the Notch pathway indicated that Notch signaling in the BLA suppresses fear memory consolidation. Impairment of fear memory consolidation after inhibition of miR-34a within the BLA is rescued by inhibiting Notch signaling. Together, these data suggest that within the BLA, a transient decrease in Notch signaling, via miR-34a regulation, is important for the consolidation of fear memory. This work expands the idea that developmental molecules have roles in adult behavior and that existing interventions targeting them hold promise for treating neuropsychiatric disorders.
