Encouraging the use of the Veterans Crisis Line among high-risk Veterans: A randomized trial of a Crisis Line Facilitation intervention.

The Veterans Crisis Line (VCL) is a core component of VA's suicide prevention strategy. Despite the availability and utility of the VCL, many Veterans do not utilize this resource during times of crisis. A brief, psychoeducational behavioral intervention (termed Crisis Line Facilitation [CLF]) was developed to increase utilization of the VCL and reduce suicidal behaviors in high-risk Veterans. The therapist-led session includes educational information regarding the VCL, as well as a chance to discuss the participant's perceptions of contacting the VCL during periods of crisis. The final component of the session is a practice call placed to the VCL by both the therapist and the participant. The CLF intervention was compared to Enhanced Usual Care (EUC) during a multi-site randomized clinical trial for 307 Veteran participants recently hospitalized for a suicidal crisis who reported no contact with the VCL in the prior 12 months. Initial analyses indicated that participants randomized to the CLF intervention were less likely to report suicidal behaviors, including suicide attempts compared to participants randomized to receive EUC over 12-months of follow-up (χ2 = 18.48/p < 0.0001), however this effect was not sustained when analyses were conducted on an individual level. No significant differences were found between conditions on VCL utilization. Initial evidence suggests a brief CLF intervention has an impact on preventing suicidal behaviors in Veterans treated in inpatient mental health programs; however, it may not change use of the VCL. This brief intervention could be easily adapted into clinical settings to be delivered by standard clinical staff.

RESULTS OF COMPUTED TOMOGRAPHY IN DOGS WITH SUSPECTED WOODEN FOREIGN BODIES.

Detection of wooden foreign bodies in dogs can be challenging. A retrospective, cross-sectional study was done to describe computed tomographic (CT) signs associated with wooden foreign bodies, and to estimate the accuracy of CT for detection of wooden foreign bodies. Patient records and CT images were reviewed for 72 dogs that had a history of suspected stick injury and CT of the affected body part, or possible wooden foreign object reported on CT, and had surgical exploration during the same period of hospitalization. Duration of clinical signs was acute in 48 (67%) dogs and chronic in 24 (33%). Wood was removed from 55 dogs, including a piece of a tree or shrub in 33 (60%) instances, kebab stick in 8 (15%), piece of bamboo garden cane in 2 (4%), cocktail stick in 2 (4%), thorn in 1 (2%), and unidentified wood in the remaining nine instances. Based on review of CT images with knowledge of the surgical findings, sensitivity of CT for wooden foreign bodies was 79% (95% CI 65%-89%), specificity 93% (78%-98%), positive likelihood ratio 11.5 (2.9-44.1), and negative likelihood ratio 0.23 (0.13-0.41). Wooden foreign bodies were predominantly rectangular or linear, with median length 48 mm (range 2-270 mm), median thickness 3 mm (range 1-22 mm), and median attenuation 111 HU (range -344 to +640 HU). A CT finding of gas in soft tissues was significantly associated with acute cases, whereas suspected foreign material, cavitary lesions, fat stranding, and periosteal reaction on adjacent bones were associated with chronic cases.

Olanzapine versus lithium in the acute treatment of bipolar mania: a double-blind, randomized, controlled trial.

BACKGROUND: This multicenter, double-blind, randomized, controlled study conducted in China examined the efficacy and safety of olanzapine versus lithium in the treatment of patients with bipolar manic/mixed episodes. METHODS: Patients with bipolar manic or mixed episode (DSM-IV criteria) and Young Mania Rating Scale (YMRS) score> or =20 at screening received olanzapine (5-20 mg/day, n=69) or lithium carbonate (600-1800 mg/day, n=71) for 4 weeks. The primary outcome was mean change from baseline in Clinical Global Impressions-Bipolar Version Overall Severity of Illness (CGI-BP) score. Secondary efficacy measures included YMRS, Brief Psychiatric Rating Scale (BPRS), and Montgomery-Asberg Depression Rating Scale (MADRS) scores. Safety was also assessed. RESULTS: A significantly greater mean change was observed in olanzapine versus lithium patients in CGI-BP (Overall Severity) (P=0.009), YMRS (P=0.013), BPRS (P=0.032), and CGI-BP (Severity of Mania) (P=0.012) scores. More olanzapine than lithium patients experienced at least one adverse event possibly related to study drug (P=0.038). More olanzapine patients had a clinically significant weight increase (> or =7% of baseline weight) compared to lithium patients (P=0.009). More olanzapine patients completed the study than lithium patients, although this difference was not statistically significant (olz, 91.3%; lith, 78.9%; P=0.057). LIMITATIONS: No placebo arm was included; however both treatments have previously been reported to be more effective than placebo. CONCLUSIONS: These results suggest that olanzapine has superior efficacy to lithium in the acute treatment of patients with bipolar mania over a 4-week period. However, adverse events were experienced by a greater number of olanzapine patients than lithium patients.