"FREED instils a bit of hope in the eating disorder community that things can change.": an investigation of clinician views on implementation facilitators and challenges from the rapid scaling of the First Episode Rapid Early Intervention for Eating Disorders programme.

Introduction: First Episode Rapid Early Intervention for Eating Disorders (FREED) is the leading eating disorder (ED) early intervention model for young people. Research has shown that it reduces the duration of untreated illness, improves clinical outcomes, and has cost savings. However, less is known about the experience of implementing FREED. This study aimed to investigate the views and experiences of adopting, implementing, and sustaining FREED from the perspective of clinical staff. Methods: Seven focus groups were conducted involving 26 clinicians. Thematic analysis was used, with the Non-Adoption, Abandonment and Challenges to Scale-up, Spread and Sustainability (The NASSS framework) framework being applied to organise subthemes and determine facilitators and barriers. The NASSS framework was also used to rate the complexity of themes as either simple (straightforward, predictable, few components), complicated (multiple interrelating components), or complex (dynamic, unpredictable, not easily divisible into constituent components). Results: There were 16 subthemes identified under seven broader themes representing each domain of the NASSS framework. Key barriers and areas of complexity included factors related to EDs as an illness (e.g., high acuity and prevalence), and organisational complexity (e.g., staffing shortages, lack of managerial/team support). Key facilitators included positive clinician/adopter attitudes, a supportive national network, and the ability for FREED to be flexible/adaptable over time. Conclusion: The FREED model appears to be desirable to clinical staff. Wider team and managerial support was perceived to be particularly important to its successful implementation, as were the national network and supervision. Key areas of complexity include staffing issues and high ED acuity/prevalence. These barriers to implementation need to be managed and investment continued to expand and improve early intervention for EDs further.

From Psoriasis to Psoriatic Arthritis: Ultrasound Insights Connecting Psoriasis with Subclinical Musculoskeletal Inflammation and the Path to Psoriatic Arthritis.

PURPOSE OF REVIEW: This review summarizes the literature about the transition from psoriasis to psoriatic arthritis (PsA), focusing on musculoskeletal ultrasound (MSUS) for detecting subclinical inflammation and its role in diagnosis and triage of high-risk patients. RECENT FINDINGS: MSUS effectively detects subclinical musculoskeletal inflammation in patients with psoriasis; however, some of these lesions are non-specific and can be found in healthy individuals. Preliminary evidence suggest that subclinical sonographic findings may predict progression to PsA in psoriasis patients. MSUS can also improve referrals' accuracy and its integration in the PsA classification criteria may improve early PsA detection. MSUS is a valuable tool for detecting subclinical abnormalities in psoriasis patients, which indicate an increased likelihood of progressing to PsA. Its integration into referral protocols and clinical use could improve PsA diagnosis. We propose an MSUS-inclusive algorithm for PsA referrals and triage, which requires validation. The potential of early intervention in reducing PsA progression in psoriasis patients with subclinical inflammation remains to be established.

The challenges for early intervention and its effects on the prognosis of autism spectrum disorder: a systematic review.

Autism spectrum disorder (ASD) is expressed with neurobehavioral symptoms of different degrees of intensity. It is estimated that, for every three cases detected, there are two cases that reach adulthood without treatment. Objective: To establish what challenges are still present in the implementation of early intervention (EI) and its effects on the prognosis of ASD. Methods: A systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Prisma) methodology was carried out in the PubMed and ScienceDirect databases in January 2023. The search keywords were "autism spectrum disorder", "early intervention" and "prognosis". Results: Sixteen studies were included, two randomized and 14 non-randomized. Knowledge about the signs of ASD, diagnostic and therapeutic methods, age at the start of treatment, and socioeconomic factors were the main challenges encountered in the implementation of the EI. Conclusion: EI is capable of modifying the prognosis of ASD and challenges in its implementation persist, especially in developing regions with low socioeconomic status.

O transtorno do espectro autista (TEA) expressa-se com sintomas neurocomportamentais de diferentes graus de intensidade. Estima-se que, para cada três casos detectados, existam dois casos que atingem a idade adulta sem tratamento. Objetivo: Estabelecer quais são os desafios ainda presentes na implementação efetiva da intervenção precoce (IP) e quais são os seus efeitos no prognóstico do TEA. Métodos: Revisão sistemática com a metodologia Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Prisma) foi realizada nos bancos de dados PubMed e ScienceDirect em janeiro de 2023. As palavras-chave da pesquisa foram "autism spectrum disorder", "early intervention" e "prognosis". Resultados: Dezesseis estudos foram incluídos, sendo dois randomizados e 14 não randomizados. O conhecimento sobre os sinais do TEA, os métodos diagnósticos e terapêuticos, a idade de início de tratamento e os fatores socioeconômicos foram os principais desafios encontrados na implementação da IP. Conclusão: A IP é capaz de modificar o prognóstico do TEA e os desafios em sua implementação ainda afetam, principalmente, regiões em desenvolvimento e de baixo status socioeconômico.

The Australian Traumatic Brain Injury Initiative: Systematic Review of the Effect of Acute Interventions on Outcome for People With Moderate-Severe Traumatic Brain Injury.

The Australian Traumatic Brain Injury Initiative (AUS-TBI) is developing a data resource to enable improved outcome prediction for people with moderate-severe TBI (msTBI) across Australia. Fundamental to this resource is the collaboratively designed data dictionary. This systematic review and consultation aimed to identify acute interventions with potential to modify clinical outcomes for people after msTBI, for inclusion in a data dictionary. Standardized searches were implemented across bibliographic databases from inception through April 2022. English-language reports of randomized controlled trials (RCTs) evaluating any association between any acute intervention and clinical outcome in at least 100 patients with msTBI, were included. A predefined algorithm was used to assign a value to each observed association. Consultation with AUS-TBI clinicians and researchers formed the consensus process for interventions to be included in a single data dictionary. Searches retrieved 14,455 records, of which 124 full-length RCTs were screened, with 35 studies included. These studies evaluated 26 unique acute interventions across 21 unique clinical outcomes. Only 4 interventions were considered to have medium modifying value for any outcome from the review, with an additional 8 interventions agreed upon through the consensus process. The interventions with medium value were tranexamic acid and phenytoin, which had a positive effect on an outcome; and decompressive craniectomy surgery and hypothermia, which negatively affected outcomes. From the systematic review and consensus process, 12 interventions were identified as potential modifiers to be included in the AUS-TBI national data resource.

Contemporary management of acute heart failure in the emergency department and the potential impact of early diuretic therapy on outcomes.

OBJECTIVE: Acute heart failure (AHF) is one of the most common conditions presenting to the ED and patients often require hospitalisation. Emerging evidence suggests early diagnosis and administration of diuretics are associated with improved patient outcomes. Currently, there is limited literature on the management of AHF in the Australian ED context. METHODS: A retrospective review of consecutive AHF presentations to the ED in a metropolitan hospital. Patient demographics, clinical status and management were assessed including timeliness of diuretics administration and association with outcomes including ED length of stay (LOS) and inpatient mortality using linear regression. RESULTS: One hundred and ninety-one presentations (median age 81 years, 50.8% male) were identified. Common cardiovascular comorbidities were prevalent. Fifty-four patients (28.3%) had ≥1 clinical high-risk feature at presentation. The median time from presentation to furosemide administration was 187 min (interquartile range 97-279 min); only 35 patients received diuretics within 60 min of presentation. Early diuretics was associated with shorter ED LOS (246 min vs 275 min, P = 0.03) and a lower but non-significant inpatient mortality (4.9% vs 6.3%, P = 0.21) and a non-significant increased rate of discharge home from ED (8.6% vs 4.7%, P = 0.15). The likelihood of discharge home was significantly more pronounced in patients receiving early diuretics without clinical high-risk features (16.7% vs 4.3%, P = 0.028). CONCLUSION: Despite symptoms and signs being well recognised at presentation, time to diuretics was relatively long. Early diuretics administration was associated with improved patient outcomes, particularly in clinically more stable patients. Due to the limitations of the study design, results should be interpreted with caution and warrant further research to identify factors that delay timely administration of diuretics.

Mechanism and prevention of liver failure complicated by acute pancreatitis / 临床肝胆病杂志

Liver failure often has rapid progression， multiple complications， and dangerous conditions. Acute pancreatitis is a common comorbidity during the progression of liver failure， and since acute pancreatitis has extremely similar clinical symptoms and signs to liver failure complicated by spontaneous peritonitis， it is often neglected in clinical practice. This article elaborates on the mechanisms of liver failure complicated by acute pancreatitis from the five aspects of inflammatory response， duodenal papillary dysfunction， gut microbiota dysbiosis， oxidative stress， and microcirculatory disturbance and proposes corresponding preventive measures based on these mechanisms.

The challenges for early intervention and its effects on the prognosis of autism spectrum disorder: a systematic review / Os desafios para a intervenção precoce e seus efeitos no prognóstico do transtorno do espectro autista: uma revisão sistemática

ABSTRACT. Autism spectrum disorder (ASD) is expressed with neurobehavioral symptoms of different degrees of intensity. It is estimated that, for every three cases detected, there are two cases that reach adulthood without treatment. Objective: To establish what challenges are still present in the implementation of early intervention (EI) and its effects on the prognosis of ASD. Methods: A systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Prisma) methodology was carried out in the PubMed and ScienceDirect databases in January 2023. The search keywords were "autism spectrum disorder", "early intervention" and "prognosis". Results: Sixteen studies were included, two randomized and 14 non-randomized. Knowledge about the signs of ASD, diagnostic and therapeutic methods, age at the start of treatment, and socioeconomic factors were the main challenges encountered in the implementation of the EI. Conclusion: EI is capable of modifying the prognosis of ASD and challenges in its implementation persist, especially in developing regions with low socioeconomic status.

RESUMO. O transtorno do espectro autista (TEA) expressa-se com sintomas neurocomportamentais de diferentes graus de intensidade. Estima-se que, para cada três casos detectados, existam dois casos que atingem a idade adulta sem tratamento. Objetivo: Estabelecer quais são os desafios ainda presentes na implementação efetiva da intervenção precoce (IP) e quais são os seus efeitos no prognóstico do TEA. Métodos: Revisão sistemática com a metodologia Preferred Reporting Items for Systematic Reviews and Meta-Analyses (Prisma) foi realizada nos bancos de dados PubMed e ScienceDirect em janeiro de 2023. As palavras-chave da pesquisa foram "autism spectrum disorder", "early intervention" e "prognosis". Resultados: Dezesseis estudos foram incluídos, sendo dois randomizados e 14 não randomizados. O conhecimento sobre os sinais do TEA, os métodos diagnósticos e terapêuticos, a idade de início de tratamento e os fatores socioeconômicos foram os principais desafios encontrados na implementação da IP. Conclusão: A IP é capaz de modificar o prognóstico do TEA e os desafios em sua implementação ainda afetam, principalmente, regiões em desenvolvimento e de baixo status socioeconômico.

Effects of internet-based, psychosocial, and early medical interventions on professional burnout in health care workers: Systematic literature review and meta-analysis.

Background: The prevalence of professional burnout increased among healthcare workers during the coronavirus 2019 (COVID-19) pandemic, with negative effects on their mental health. Consequently, research interest in methods to decrease the prevalence of burnout and reduce the effects of burnout on healthcare workers has increased. Objective: This study was designed to evaluate the effects of Internet-based, psychosocial, and early medical interventions on professional burnout among healthcare workers. Methodology: This systematic review and meta-analysis involved 8004 articles identified from four databases: Cochrane, Web of Science, PubMed/Medline, and clinical trials. Results: Four articles were included in the systematic review, of which two could be meta-analyzed. The pooled effect of the group of interventions compared to control conditions was not statistically significant. Discussion: Evaluating therapeutic effectiveness requires more clinical trials that allow its evaluation. Although we did not find improvements in the three intervention categories, the methodological heterogeneity in each intervention and the need for a standardized intervention guide for managing and decreasing professional burnout, subject to the evaluation of its impact, are highlighted.

Long-term outcomes of delayed clozapine initiation in treatment-resistant schizophrenia: a multicenter retrospective cohort study.

BACKGROUND: Clozapine is the only antipsychotic medication with proven efficacy against treatment-resistant schizophrenia. This multicenter retrospective cohort study aimed to evaluate the impact of a delay in clozapine initiation on long-term outcomes. METHODS: Patients who initiated clozapine treatment between July 2009 and December 2018 were included in this study. According to the length of time from the diagnosis of schizophrenia to clozapine initiation, the patients were categorized into one of three groups: early (≤ 9 years), intermediate (10-19 years), and late (≥ 20 years) initiation. The endpoints were psychiatric rehospitalization and all-cause clozapine discontinuation within 3 years. Hazard ratios (HR) and 95% confidence interval (CI) were estimated using the Fine and Gray method or the Cox proportional hazards model. RESULTS: The incidence rates of rehospitalization within three years, according to the cumulative incidence function, were 32.3% for early, 29.7% for intermediate, and 62.2% for late initiation, respectively. Late initiation had a significantly higher risk of psychiatric rehospitalization than early initiation (HR, 2.94; 95% CI, 1.01- 8.55; P = 0.016 by the Gray's test). The risk of psychiatric rehospitalization was not significantly different between the early and intermediate initiation groups. The incidence rate of all-cause clozapine discontinuation within three years using the Kaplan-Meier method was 13.0% for early, 10.6% for intermediate, and 20.1% for late initiation. The risk of all-cause clozapine discontinuation was not significantly among the groups. The late initiation group had more patients discontinuing because of death due to physical diseases than the other groups. CONCLUSIONS: The study suggests that clozapine should be initiated promptly in patients with treatment-resistant schizophrenia to prevent psychiatric rehospitalization during long-term treatment. Further prospective studies with appropriate consideration of confounding factors and large sample sizes are needed to strengthen the evidence.

Safety and efficacy of ultrasonography of tension after zone II flexor tendon repair: A randomized controlled trial.

BACKGROUND: Primary flexor tendon repairs of lacerations in zone II of the hand are fraught with problems. Traditionally, exercise (active and passive), orthoses, and physical agents are common interventions for the rehabilitation of patients experiencing these issues. One area of focus in this field is how to safely utilize tension to lengthen gliding distance following zone II injury. Finding effective solutions in this area is a key priority for improving patient outcomes and quality of life. PURPOSE: To identify the optimal immobilization position that meets safety standards for tension and is the most efficient, and consequently, to validate our clinical effectiveness. STUDY DESIGN: A cross-sectional study was adopted for the first part of the research (Research 1). A prospective, parallel, 2-group, randomized trial was conducted with concealed allocation and single blinding in the second part of the research (Research 2). METHODS: A total of 60 healthy adults were recruited to select the best-fit protective immobilization position in Research 1, which was confirmed by tendon tension (via Young's modulus) and excursion (via gliding distance). We then randomly assigned 45 patients after zone II flexor tendon repair into two groups in Research 2 to compare functional outcomes. The control group underwent the conventional modified Duran protocol with early passive motion, while the experimental group received the protocol (optimized by Research 1) with early active motion. Ultrasonography was used to measure the tension and excursion of the flexor tendons. The outcomes measured at 16 weeks post-repair included total active motion, strength, the Disabilities of the Arm, Shoulder and Hand, and Strickland scores. RESULTS: Three participants were unable to participate in Research 2 due to medical issues and poor attendance. The investigation found that the safe tendon threshold was 345.09 ± 87.74 kPa for partial active digital motion among the 60 participants. The optimal immobilization position requires the wrist to be neutral with a flexion angle of 30° at the metacarpophalangeal joint. The grip strengths (p = 0.012), ratio of grip strength (p = 0.015), the Disabilities of the Arm, Shoulder and Hand (p = 0.036), and total active motion (p = 0.023) differed significantly between the two groups. CONCLUSIONS: Protective immobilization of the wrist in a neutral flexion position and with the metacarpophalangeal joint flexed at 30° can secure the repaired flexor tendon safely and efficiently. The effects of an early active motion protocol may improve the grip strength and upper limb mobility of individuals after zone II flexor tendon repair. CLINICAL TRIAL REGISTRATION: ChiCTR2000030592.

Educating sports people about CPR and first aid in general practice: the Savtember project.

AIM: During an exercise-related sudden cardiac arrest, bystander automated external defibrillator use occurred in a median of 31%. The present study conducted in France evaluated the feasibility and impact of a brief intervention by general practitioners (GPs) to increase awareness about first aid/CPR training among amateur sportspeople. METHODS: In 2018, 49 French GPs proposed a brief intervention to all patients who attended a consultation in order to obtain a medical certificate attesting their fitness to participate in sports. The brief intervention included two questions (Have you been trained in first aid? Would you like to attend a first aid course?) and a flyer on first aid. The GPs' opinion of the feasibility of the brief intervention was evaluated during a subsequent interview (primary objective). The percentage of sportspeople who started a first aid/CPR course within three months was used as a measure of the effectiveness of the brief intervention (secondary objective). FINDINGS: Among 929 sportspeople, 37% were interested in first aid training and received the flyer (4% of these started a training course within three months of the brief intervention, a training rate that was 10 times greater than among the general French population), 56% were already trained, and 7% were not interested. All GPs found the brief intervention feasible and fast (<3 min for 80% of GPs). We conclude the brief intervention to promote first aid/CPR awareness is easy to use and may be an effective although limited means of promoting CPR training. It opens a previously unexplored avenue for GP involvement in promoting training.

Aberrant Salience Inventory: A meta-analysis to investigate its psychometric properties and identify screening cutoff scores.

INTRODUCTION: The Aberrant Salience Inventory (ASI) is a useful tool to measure salience abnormalities among the general population. There is strong clinical and scientific evidence that salience alteration is linked to psychosis. To the present day, no meta-analysis evaluating ASI's psychometric properties and screening potential has been published. MATERIALS AND METHODS: PubMed, Google Scholar, Scopus, and Embase were searched using terms including "psychosis," "schizophrenia," and "Aberrant Salience Inventory." Observational and experimental studies employing ASI on populations of non-psychotic controls and patients with psychosis were included. ASI scores and other demographic measures (age, gender, ethnicity) were extracted as outcomes. Individual patients' data (IPD) were collected. Exploratory factor analysis (EFA) was performed on the IPD. RESULTS: Eight articles were finally included in the meta-analysis. ASI scores differ significantly between psychotic and non-psychotic populations; a novel three-factor model is proposed regarding subscales structure. Theoretical positive predictive values (PPVs) and negative predictive values (NPVs) were calculated and presented together with different cutoff points depending on preselected specific populations of interest. DISCUSSION: PPV and NPV values reached levels adequate for ASI to be considered a viable screening tool for psychosis. The factor analysis highlights the presence of a novel subscale that was named "Unveiling experiences." Implications regarding the meaning of the new factor structure are discussed, as well as ASI's potential as a screening tool.

Long-Term Outcomes of Early Coronary Artery Disease Testing After New-Onset Heart Failure.

BACKGROUND: Coronary artery disease (CAD) testing remains underutilized in patients with newly diagnosed heart failure (HF). The longitudinal clinical impact of early CAD testing has not been well-characterized. We investigated changes in clinical management and long-term outcomes after early CAD evaluation in patients with incident HF. METHODS: We identified Medicare patients with incident HF from 2006 to 2018. The exposure variable was early CAD testing within 1 month of initial HF diagnosis. Covariate-adjusted rates of cardiovascular interventions after testing, including CAD-related management, were modeled using mixed-effects regression with clinician as a random intercept. We assessed mortality and hospitalization outcomes using landmark analyses with inverse probability-weighted Cox proportional hazards models. Falsification end points and mediation analysis were employed for bias assessment. RESULTS: Among 309 559 patients with new-onset HF without prior CAD, 15.7% underwent early CAD testing. Patients who underwent prompt CAD evaluation had higher adjusted rates of subsequent antiplatelet/statin prescriptions and revascularization, guideline-directed therapy for HF, and stroke prophylaxis for atrial fibrillation/flutter than controls. In weighted Cox models, 1-month CAD testing was associated with significantly reduced all-cause mortality (hazard ratio, 0.93 [95% CI, 0.91-0.96]). Mediation analyses indicated that ≈70% of this association was explained by CAD management, largely from new statin prescriptions. Falsification end points (outpatient diagnoses of urinary tract infection and hospitalizations for hip/vertebral fracture) were nonsignificant. CONCLUSIONS: Early CAD testing after incident HF was associated with a modest mortality benefit, driven mostly by subsequent statin therapy. Further investigation on clinician barriers to testing and treating high-risk patients may improve adherence to guideline-recommended cardiovascular interventions.

Outcomes of A Virtual Practice-Tailored Medicare Annual Wellness Visit Intervention.

INTRODUCTION: Interventions are needed to promote utilization of the Medicare Annual Wellness Visit (AWV), an underused opportunity to perform screenings and plan individualized preventive health services. METHOD: Using remote practice redesign and electronic health record (EHR) support, we implemented the Practice-Tailored AWV intervention in 2021 (during the COVID-19 pandemic) in 3 small community-based practices. The intervention combines EHR-based tools with practice redesign approaches and resources. Outcomes included completion of AWV and fulfillment of recommended preventive services. RESULTS: At baseline the 3 practices had 1,513 Medicare patients with at least 1 visit in the past 12 months. AWV utilization went from 7% at baseline to 54% 8 months postintervention implementation; advance care planning increased 10.7% (from 7.9% to 18.6%); depression screening increased 16.3% (from 51.7% to 68.0%); and alcohol misuse screening increased 17.3% (from 42.6% to 59.9%). Every individual preventive health service was received more often by patients with an AWV than those without. At the patient level, fulfillment of all eligible preventive services (of a maximum of 12 evaluated) went from 47.5% to 53.8% (P < .001). Subgroup analyses showed that patients with AWVs completed a greater percentage of their total recommended preventive health services than those without an AWV. CONCLUSION: Virtual implementation of an intervention that combined EHR-based tools with practice redesign approaches increased AWV and preventive services utilization in Medicare patients. Given the success of this intervention during the COVID-19 pandemic (when practices had many competing demands), greater consideration should be given to delivering future interventions virtually.

Early tracheostomy versus late tracheostomy in severe traumatic brain injury or stroke: A systematic review and meta-analysis.

OBJECTIVES: We aim to ascertain whether the benefit of early tracheostomy can be found in patients with severe traumatic brain injury (TBI) and stroke and if the benefit will remain considering distinct pathologies. DATA SOURCES: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol, a search through Lilacs, PubMed, and Cochrane databases was conducted. REVIEW METHODS: Included studies were those written in English, French, Spanish, or Portuguese, with a formulated question, which compared outcomes between early and late trach (minimum of two outcomes), such as intensive care unit (ICU) length of stay (LOS), duration of mechanical ventilation (MV), hospital LOS, mortality rates, or ventilator-associated pneumonia (VAP). Likewise, patients presented exclusively with head injury or stroke had minimum hospital stay follow-up, and as for severe TBI patients, they presented Glasgow Coma Scale ≤8 at admission. Evaluated outcomes were the risk ratio (RR) of VAP, risk difference (RD) of mortality, and mean difference (MD) of the duration of MV, ICU LOS, and hospital LOS. RESULTS: The early and late tracheostomy cohorts were composed of 6211 and 8140 patients, respectively. The meta-analysis demonstrated that the early tracheostomy cohort had a lower risk for VAP (RR: 0.73 [95% confidence interval {CI}, 0.66, 0.81] p < 0.00001), shorter duration of MV (MD: -4.40 days [95% CI, -8.28, -0.53] p = 0.03), and shorter ICU (MD: -6.93 days [95% CI, -8.75, -5.11] p < 0.00001) and hospital LOS (MD: -7.05 days [95% CI, -8.27, -5.84] p < 0.00001). The mortality rate did not demonstrate a statistical difference. CONCLUSION: Early tracheostomy could optimise patient outcomes by patients' risk for VAP and decreasing MV durationand ICU and hospital LOS.

Analyzing User-Generated Web-Based Posts of Adolescents' Emotional, Behavioral, and Symptom Responses to Beliefs About Depression: Qualitative Thematic Analysis.

BACKGROUND: Depression is common during adolescence. Early intervention can prevent it from developing into more progressive mental disorders. Combining information technology and clinical psychoeducation is a promising way to intervene at an earlier stage. However, data-driven research on the cognitive response to health information targeting adolescents with symptoms of depression is lacking. OBJECTIVE: This study aimed to fill this knowledge gap through a new understanding of adolescents' cognitive response to health information about depression. This knowledge can help to develop population-specific information technology, such as chatbots, in addition to clinical therapeutic tools for use in general practice. METHODS: The data set consists of 1870 depression-related questions posted by adolescents on a public web-based information service. Most of the posts contain descriptions of events that lead to depression. On a sample of 100 posts, we conducted a qualitative thematic analysis based on cognitive behavioral theory investigating behavioral, emotional, and symptom responses to beliefs associated with depression. RESULTS: Results were organized into four themes. (1) Hopelessness, appearing as a set of negative beliefs about the future, possibly results from erroneous beliefs about the causal link between risk factors and the course of depression. We found beliefs about establishing a sturdy therapy alliance as a responsibility resting on the patient. (2) Therapy hesitancy seemed to be associated with negative beliefs about therapy prognosis and doubts about confidentiality. (3) Social shame appeared as a consequence of impaired daily function when the cause is not acknowledged. (4) Failing to attain social interaction appeared to be associated with a negative symptom response. In contrast, actively obtaining social support reduces symptoms and suicidal thoughts. CONCLUSIONS: These results could be used to meet the clinical aims stated by earlier psychoeducation development, such as instilling hope through direct reattribution of beliefs about the future; challenging causal attributions, thereby lowering therapy hesitancy; reducing shame through the mechanisms of externalization by providing a tentative diagnosis despite the risk of stigmatizing; and providing initial symptom relief by giving advice on how to open up and reveal themselves to friends and family and balance the message of self-management to fit coping capabilities. An active counseling style advises the patient to approach the social environment, demonstrating an attitude toward self-action.

National roll-out of early intervention for eating disorders: Process and clinical outcomes from first episode rapid early intervention for eating disorders.

AIM: First Episode Rapid Early Intervention for Eating Disorders (FREED) is an early intervention model for young people with recent-onset eating disorders (ED). Promising results from a previous single-centre study and a four-centre study (FREED-Up) have led to the rapid national scaling of FREED to ED services in England (FREED-4-All). Our aim was to evaluate duration of an untreated ED (DUED), wait time target adherence, and clinical outcomes in FREED-4-All and compare these to the (benchmark) findings of the earlier FREED-Up study. METHOD: FREED services submit de-identified data to the central FREED team quarterly. The current study covers the period between September 2018 and September 2021. This FREED-4-All dataset includes 2473 patients. These were compared to 278 patients from the FREED-Up study. RESULTS: DUED was substantially shorter in the FREED-4-All dataset relative to the FREED-Up study (15 vs. 18 months). Adherence to the wait time targets was comparable in both cohorts (~85% of engagement calls attempted in <2 days, ~50%-60% of assessments offered in <14 days, ~40% of treatment offered in <28 days). Patients in the FREED-4-All dataset experienced significant improvements in ED and general psychological symptoms from pre- to post-treatment that were comparable to the FREED-Up study. These findings should be interpreted cautiously as only 6% of FREED-4-All patients had post-treatment data. CONCLUSIONS: Data from the FREED-4-All evaluation suggest that FREED is replicating at scale. However, these data are flawed, uncertain, proximate, and sparse and should therefore be used carefully alongside other evidence and clinical experience to inform decision making.

Predictive factors of autogenous arteriovenous fistula maturation and preliminary study on assisted maturation intervention timing / 中华肾脏病杂志

Objective:To analyze the predictive factors of autogenous arteriovenous fistula (AVF) maturation and tentatively discuss the intervention timing of assisted maturation.Methods:It was a retrospective study. The data of patients with newly established AVF and regular follow-up in Haidian Hospital, the Third Hospital of Peking University from August 1, 2018 to March 31, 2022 were analyzed. The patients were divided into mature group and immature group based on whether they met clinical maturity or ultrasonic maturity criteria 3 months after AVF establishment.The general data, preoperative laboratory examination and postoperative ultrasonic examination parameters were compared between the two groups. Logistic regression analysis model was used to analyze the related factors of AVF maturation, and receiver operating characteristic curve (ROC curve) was drawn to evaluate the predictive value of each factor for AVF maturation and intervention timing.Results:A total of 568 patients were included, with age of (56.86±13.82) years old, 339 males (59.68%), and 229 females (40.32%). There were 380 patients in the maturation group and 188 patients in the immature group. The total rate of AVF maturation was 66.90% (380/568). The anastomosis diameter ( t=9.732, P < 0.001), ln(anastomosis artery diameter)( t=10.116, P < 0.001), anastomosis vein diameter ( t=13.961, P < 0.001), ln(brachial artery diameter)( t=9.362, P < 0.001) and brachial artery blood flow ( t=16.542, P < 0.001) of postoperation one month, and anastomosis diameter ( t=7.356, P < 0.001), anastomosis artery diameter ( t=11.117, P < 0.001), anastomosis vein diameter ( t=12.332, P < 0.001), ln(brachial artery diameter) ( t=7.956, P < 0.001) and brachial artery blood flow ( t=13.803, P < 0.001) of postoperation three months in the mature group were significantly higher than those in the immature group. Logistic regression analysis models showed anastomosis vein diameter at 1 month after surgery ( OR=0.577, 95% CI 0.342-0.975, P=0.040), brachial arterial blood flow at 1 month after surgery ( OR=0.988, 95% CI 0.996-1.000, P=0.043) and brachial arterial blood flow at 3 months after surgery ( OR=0.997, 95% CI 0.995-0.999, P=0.002) were the independent relevant factors of AVF maturation. When the anastomosis vein diameter ≥ 3.90 mm at 1 month after AVF surgery ( AUC=0.842, 95% CI 0.809-0.871, P < 0.001), the blood flow of brachial artery ≥ 446.90 ml/min at 1 month after AVF surgery ( AUC=0.880, 95% CI 0.850-0.906, P < 0.001), the critical value of the combined index of anastomotic vein diameter and blood flow of brachial artery at 1 month after fitting ≥ 0.44 ( AUC=0.889, 95% CI 0.860-0.914, P < 0.001) and brachial arterial blood flow ≥ 595.00 ml/min ( AUC=0.857, 95% CI 0.822-0.888, P < 0.001), the unassisted maturation of AVF could be predicted. Conclusions:The anastomosis vein diameter ≥ 3.90 mm at 1 month after AVF surgery, and the blood flow of brachial artery ≥ 446.90 ml/min at 3 months after AVF surgery, or the critical value of combined index of both after fitting ≥ 0.44 can predict the unassisted maturation of AVF, and one month after surgery may be the opportunity for early intervention to promote maturation.

Analysis of risk factors for failure in the treatment of early periprosthetic joint infection by debridement, antibioticsand implant retention combined with intra-articular injection of antibiotics / 中华骨科杂志

Objective:To analyze the risk factors leading to the failure of early periprosthetic joint infection (PJI) treated by debridement, antibiotics and implant retention (DAIR) combined with intra-articular injection of antibiotics.Methods:A total of 100 patients who received DAIR combined with intra-articular injection of antibiotics between January 2010 and October 2020 in the Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University, were retrospectively analyzed. There were 47 males and 53 females, with an average age of 62.8±13.0 years (26-84 years). 75 patients were diagnosed as PJI after primary surgery while 25 PJI after revision or debridement, involving 41 hips and 59 knees. According to the clinical outcomes, the patients were divided into the cured group (78 cases) and the uncured group (22 cases). Risk factors were screened by univariate analysis on their gender, age, body mass index, site of infection (hip/knee), synovial white blood cell count, erythrocyte sedimentation rate (ESR), C reactive protein (CRP), time of infection, types of pathogenic bacteria (gram-positive bacteria, gram-negative bacteria or fungi), preoperative sinus tract and previous surgical history. For the factors with P<0.20, multivariate binary logistic regression analysis was performed to determine the independent risk factors. Kaplan-Meier survival curve was drawn and any cause that led to treatment failure was seen as the end point event. Calculate prosthetic survival time and 10-year survival rate. Results:The average follow-up was 59.8±40.6 months (0.3-129.0 months). The infection control rate of DAIR combined with intra-articular injection of antibiotics in the treatment of early PJI was 78% (78/100). The univariate analysis showed that the successful rate of non-fungal infection group (81%, 77/95) was significantly higher than the fungal infection group (20%, 1/5) and the successful rate of the group without previous surgical history (85.3%, 64/75) was significantly higher than that with previous surgical history (56.0%, 14/25, χ 2=7.07, P=0.008; χ 2=9.40, P=0.002). The multivariate binary Logistic regression analysis showed that fungal infection [ OR=0.08, 95% CI(0.01, 0.79), P=0.031] and history of previous surgical intervention [ OR=0.25, 95% CI(0.09, 0.73), P=0.001] were independent risk factors for treatment failure. Kaplan-Meier survival curves showed that the survival time of the prosthesis was 96.83±5.30 months, and the 10-year survival rate was 68.1%. Meanwhile, the survival rate of patients with fungal infection and previous surgical history was significantly lower than that of patients without fungal infection or previous surgical history, the difference was statistically significant (χ 2=15.49, P<0.001; χ 2=8.91, P=0.030). Conclusion:The time of PJI, bacterial virulence and species, and preoperative inflammatory indicators had no effect on the outcome of DAIR combined with intra-articular injection of antibiotics in the treatment of early PJI. However, DAIR was not recommended for patients with a history of surgical intervention and fungal infection.

The hip in cerebral palsy: surveillance and timely surgical intervention can prevent painful hip dislocation / 中华骨科杂志

Cerebral palsy is the most common childhood-onset neuromuscular disorder creating lifelong physical disabilities. It affects about 1 in 500 neonates with an estimated worldwide prevalence of 17 million. Cerebral palsy is not a specific disease, but a spectrum of clinical symptoms of permanent abnormalities of the development of movement and posture caused by non-progressive disturbances in a developing fetal or infant brain. Various musculoskeletal disorders are caused by cerebral palsy, hip displacement is one of the most common deformities, second only to equinus deformities of the foot and ankle.Based on the review of previous literatures, this paper summarized the pathophysiology, clinical symptoms, relationship with the gross motor functionclassification and orthopedic treatment of hip displacement in cerebral palsy. Hip displacement in cerebral palsy is mainly caused by the lack of normal stress stimulation in the early childhood and the continuous asymmetric muscle tone and muscle strength around the hip joint. Early hip displacement in cerebral palsy is usually asymptomatic, but without timely intervention hip subluxation/dislocation will cause hip pain and hip motion limitation and thus influence the patient's activity ability and increase the difficulty of daily caring. Hip displacement in cerebral palsy is closely related to the gross motor functionclassification, and the higher the classification of gross motor, the greater the risk of displacement, and hip monitoring can significantly reduce the incidence of hip dislocation. Therefore, a consensus has been reached that a standardized hip surveillance programs and timely intervention are important to prevent the occurrence of hip dislocation and pain. The surgical strategies for hip displacement in CP can be divided into three types: preventive surgery, reconstructive surgery and salvage surgery.