Use of crisis management interventions among suicidal patients: Results of a randomized controlled trial.

BACKGROUND: Previous research supports the efficacy of the crisis response plan (CRP) for the reduction of suicidal behaviors as compared to treatment as usual (TAU). Patient perspectives and use of the CRP, and their relationship to later suicidal thoughts, remain unknown. METHODS: A secondary analysis of a randomized clinical trial comparing a standard CRP (S-CRP), a CRP enhanced with reasons for living (E-CRP), and TAU in a sample of 97 active-duty U.S. Army personnel was conducted. Participants were asked about their use, perceptions, and recall of each intervention. Generalized estimating equations were used to test the conditional effects of intervention use, perceptions, and recall on severity of suicide ideation during follow-up. RESULTS: Across all treatment groups, over 80% of participants retained their written CRP up to 6 months later, but less than 25% had the written plan in their physical possession at the time of each assessment. Participants in S-CRP and E-CRP were more likely to recall self-management strategies and sources of social support. Participants in TAU were more likely to recall use of professional healthcare services and crisis management services. All three interventions were rated as highly useful. More frequent use of the E-CRP and recall of its components were associated with significantly reduced suicide ideation as compared to TAU. CONCLUSIONS: Both CRPs have high acceptability ratings. The effect of both CRPs on reduced suicide ideation is associated with patient recall of components. More frequent use of the E-CRP is associated with larger reductions in suicide ideation.

Effect of crisis response planning vs. contracts for safety on suicide risk in U.S. Army Soldiers: A randomized clinical trial.

OBJECTIVE: To evaluate the effectiveness of crisis response planning for the prevention of suicide attempts. METHOD: Randomized clinical trial of active duty Army Soldiers (N=97) at Fort Carson, Colorado, presenting for an emergency behavioral health appointment. Participants were randomly assigned to receive a contract for safety, a standard crisis response plan, or an enhanced crisis response plan. Incidence of suicide attempts during follow-up was assessed with the Suicide Attempt Self-Injury Interview. Inclusion criteria were the presence of suicidal ideation during the past week and/or a lifetime history of suicide attempt. Exclusion criteria were the presence of a medical condition that precluded informed consent (e.g., active psychosis, mania). Survival curve analyses were used to determine efficacy on time to first suicide attempt. Longitudinal mixed effects models were used to determine efficacy on severity of suicide ideation and follow-up mental health care utilization. RESULTS: From baseline to the 6-month follow-up, 3 participants receiving a crisis response plan (estimated proportion: 5%) and 5 participants receiving a contract for safety (estimated proportion: 19%) attempted suicide (log-rank χ2(1)=4.85, p=0.028; hazard ratio=0.24, 95% CI=0.06-0.96), suggesting a 76% reduction in suicide attempts. Crisis response planning was associated with significantly faster decline in suicide ideation (F(3,195)=18.64, p<0.001) and fewer inpatient hospitalization days (F(1,82)=7.41, p<0.001). There were no differences between the enhanced and standard crisis response plan conditions. CONCLUSION: Crisis response planning was more effective than a contract for safety in preventing suicide attempts, resolving suicide ideation, and reducing inpatient hospitalization among high-risk active duty Soldiers.

The Functional Human C-Terminome.

All translated proteins end with a carboxylic acid commonly called the C-terminus. Many short functional sequences (minimotifs) are located on or immediately proximal to the C-terminus. However, information about the function of protein C-termini has not been consolidated into a single source. Here, we built a new "C-terminome" database and web system focused on human proteins. Approximately 3,600 C-termini in the human proteome have a minimotif with an established molecular function. To help evaluate the function of the remaining C-termini in the human proteome, we inferred minimotifs identified by experimentation in rodent cells, predicted minimotifs based upon consensus sequence matches, and predicted novel highly repetitive sequences in C-termini. Predictions can be ranked by enrichment scores or Gene Evolutionary Rate Profiling (GERP) scores, a measurement of evolutionary constraint. By searching for new anchored sequences on the last 10 amino acids of proteins in the human proteome with lengths between 3-10 residues and up to 5 degenerate positions in the consensus sequences, we have identified new consensus sequences that predict instances in the majority of human genes. All of this information is consolidated into a database that can be accessed through a C-terminome web system with search and browse functions for minimotifs and human proteins. A known consensus sequence-based predicted function is assigned to nearly half the proteins in the human proteome. Weblink: http://cterminome.bio-toolkit.com.

Brief cognitive-behavioral therapy effects on post-treatment suicide attempts in a military sample: results of a randomized clinical trial with 2-year follow-up.

OBJECTIVE: The authors evaluated the effectiveness of brief cognitive-behavioral therapy (CBT) for the prevention of suicide attempts in military personnel. METHOD: In a randomized controlled trial, active-duty Army soldiers at Fort Carson, Colo., who either attempted suicide or experienced suicidal ideation with intent, were randomly assigned to treatment as usual (N=76) or treatment as usual plus brief CBT (N=76). Assessment of incidence of suicide attempts during the follow-up period was conducted with the Suicide Attempt Self-Injury Interview. Inclusion criteria were the presence of suicidal ideation with intent to die during the past week and/or a suicide attempt within the past month. Soldiers were excluded if they had a medical or psychiatric condition that would prevent informed consent or participation in outpatient treatment, such as active psychosis or mania. To determine treatment efficacy with regard to incidence and time to suicide attempt, survival curve analyses were conducted. Differences in psychiatric symptoms were evaluated using longitudinal random-effects models. RESULTS: From baseline to the 24-month follow-up assessment, eight participants in brief CBT (13.8%) and 18 participants in treatment as usual (40.2%) made at least one suicide attempt (hazard ratio=0.38, 95% CI=0.16-0.87, number needed to treat=3.88), suggesting that soldiers in brief CBT were approximately 60% less likely to make a suicide attempt during follow-up than soldiers in treatment as usual. There were no between-group differences in severity of psychiatric symptoms. CONCLUSIONS: Brief CBT was effective in preventing follow-up suicide attempts among active-duty military service members with current suicidal ideation and/or a recent suicide attempt.

Reconstruction of the Medial Patellofemoral Ligament: Clinical Outcomes and Return to Sports.

BACKGROUND: Recent studies have shown that medial patellofemoral ligament (MPFL) reconstruction using a standardized technique provides significant improvements in all outcome scoring systems, with low complication rates and good patient satisfaction. Although numerous studies have assessed clinical results, there is little published literature investigating return to sporting activities after reconstruction of the MPFL. PURPOSE: To demonstrate postoperative outcomes and the return-to-sports rate a minimum of 2 years after isolated MPFL reconstruction in a young patient cohort. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Between 2007 and 2010, a total of 72 isolated MPFL reconstructions (in 68 patients) were performed for recurrent patellar dislocation. Pre- and postoperative knee assessment included a thorough history of symptoms and a clinical examination consisting of crepitus, range of motion, patellofemoral pain, and patellar apprehension. Knee function was assessed using the Kujala score, International Knee Documentation Committee score, Tegner activity score, visual analog scale (VAS), and Activity Rating Scale (ARS). RESULTS: Of patients who participated in sports preoperatively (62/68 patients), 100% returned to sports after MPFL reconstruction; 53% returned at equal or higher levels, whereas 47% returned at lower levels. Fifty-four of 68 patients (79.4%) rated themselves as very satisfied or satisfied with the results. The median Kujala score improved significantly from 66 to 87.5 and the median International Knee Documentation Committee score from 60 to 79.8. The median VAS for pain score illustrated significant preoperative to postoperative improvement, from 4 to 2. Conversely, patients' activity levels according to the Tegner activity score dropped from 4.5 to 4, and the median Activity Rating Scale score dropped from 6 to 3. There was also a persistent instability rate of 10% as well as a slight loss of knee flexion in 24 of 72 knees. CONCLUSION: Reconstruction of the MPFL is a safe and effective treatment for patellofemoral instability without severe trochlear dysplasia and allows most patients to engage in regular sports activities 2 years postoperatively, at least at a recreational level. However, potential complications, such as persistent instability, pain, and loss of flexion, must be considered.

Osteoarthritis.

Internationally, prevalence estimates for osteoarthritis show wide variability depending on the age and sex of the studied population, the method of case identification used, and the specificity of joint sites included. Currently, there is no generally agreed "gold standard" for identifying cases of osteoarthritis in epidemiologic studies. Despite this lack of standardisation, it is consistently demonstrated in population-based studies, worldwide, that osteoarthritis prevalence is positively associated with increasing age and that the greatest disease burden is attributable to involvement of the hip or knee joints. To estimate the true burden of osteoarthritis involving the hips or knees, comprehensive accounting of all associated morbidity is required. The identification of modifiable risk factors for disease incidence and progression is needed.