Browsing by Subject "Outpatients"
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Item Applications of outpatient antimicrobial stewardship and therapy: the Parkland OPAT experience(2013-09-20) Bhavan, Kavita P.Item Borderline Personality Features and Treatment Outcomes in an Adolescent Intensive Outpatient Treatment Population(2016-08-25) Rial, Katherine Vera; Foxwell, Aleksandra; Kennard, Beth D.; Moore, Patricia SinclairBorderline Personality Disorder (BPD) is a common psychiatric disorder associated with severe functional impairment, high rates of suicide, comorbid mental disorders, frequent utilization of mental health treatment, and therefore, high cost to society in both adults and adolescents. Although treatments have been developed to treat BPD in adults, little is known about the effectiveness of treatments in adolescents, in particular in an intensive outpatient setting. The current study examined differences in clinical characteristics among adolescents with and without borderline features who participated in an intensive outpatient program (IOP) for suicidal behaviors. In addition, this study examined whether borderline features predicted treatment outcomes at discharge. Fifty-eight participants, ages 13-17 (14.98±1.15), were categorized into adolescents with BPD features and those without. Assessments include the Concise Health Risk Tracking form (CHRT; self-report), Columbia Suicide Severity Rating Scale (C-SSRS; clinician-rated), Quick Inventory of Depressive Symptomatology- Adolescent version (QIDS-A; self-report), and the 11-item Borderline Personality Features scale for Children (BPFSC-11; self-report). Statistical analyses include chi-square and ANOVA for demographic and clinical characteristics. Spearman's correlations and a hierarchical linear regression were used to examine treatment outcomes. Results indicate that adolescents with BPD features presented to treatment with more severe depression and suicide risk than adolescents without BPD features. Following IOP treatment, adolescents with BPD features continued to endorse more severe depressive symptoms than those without BPD features. However, there was no statistical difference between groups in regards to suicidality. The presence of BPD features did not predict depression severity at discharge, but the relationship appeared to be trending.Item Culturally Informed Motivational Interviewing to Improve Oral Chemotherapy Adherence for Pediatric Acute Lymphoblastic Leukemia Patients and Their Caregivers: A Feasibility, Acceptability, and Preliminary Efficacy Trial(2019-07-24) El Behadli Gonzalez, Ana Fey; Faith, Melissa A.; Stewart, Sunita M.; Winick, Naomi; Germann, Julie; Acosta, DailynBACKGROUND: Curative therapy for childhood acute lymphoblastic leukemia (ALL) mandates a two-to-three-year maintenance chemotherapy phase wherein patients must take daily oral 6-mercaptopurine (6-MP). 6-MP regimen adherence is challenging and failure to take medication has been associated with an increase in relapse risk. Accordingly, interventions that enhance 6-MP adherence during ALL maintenance chemotherapy may result in decreased morbidity and mortality for pediatric ALL patients. This study investigated the feasibility and acceptability of brief, English- and Spanish-delivered, culturally informed MI sessions during routine outpatient ALL maintenance therapy appointments. Additionally, this study preliminarily explored MI efficacy, compared to an education-only control, for improving caregiver-reported 6-MP adherence, patients' TGN blood serum levels, and caregiver-perceived 6-MP adherence barriers. METHOD: Participants included 121 caregivers (Age M(SD) = 36.66(8.02), 80.7% mothers, 47.1% Hispanic, 23.1% Spanish-speaking) of pediatric ALL patients (Age M(SD) = 7.55(4.80), range = .9-24; 66.1% male; Medicaid = 54.2%; B- and T-ALL risk category: Standard = 50.9%, High/Very High = 49.1%) in maintenance ALL treatment. Eighty caregivers (66.12%) were randomized to receive MI and the remaining 42 caregivers (33.8%) were randomized to the education-only control group. For the purpose of analyses, participants were categorized based on their ethnicity and primary language as a proxy for potential cultural similarities. Cultural categories included: (1) Non-Hispanic, English-speaking caregivers (N=63, 52.07%); (2) Hispanic, English-speaking caregivers (N=30, 24.79%); and (3) Hispanic, Spanish-speaking caregivers (N=28, 23.14%). Participants completed self-report measures assessing demographics, 6-MP adherence, 6-MP knowledge, perceived medication adherence barriers, and intervention acceptability. We obtained biological data (i.e., TGN concentrations) via chart review. MI sessions were audio recorded and rated using the MITI 4.2.1. coding manual to ensure intervention fidelity. Primary analyses included Analysis of Covariance (ANCOVA). We also conducted exploratory post-hoc analyses. RESULTS: Findings confirmed primary MI feasibility and acceptability hypotheses, supporting the possibility of delivering adherence-enhancing MI as part of routine oncological care. Additionally, although methodological limitations hindered adequate assessment of MI efficacy for improving caregiver-reported 6-MP adherence and patients' TGN concentration, post-hoc analyses suggested MI was effective for reducing caregiver-perceived 6-MP adherence barriers. CONCLUSIONS: MI may represent a deliverable, cost-effective, "no-risk" approach to improving adherence and represent an easily incorporated, low cost avenue for enhancing cure. Overall, study findings have the potential to inform a larger, future MI efficacy RCT by establishing the feasibility and acceptability of MI delivery during outpatient oncology clinic visits.Item Prediction by Insomnia to Treatment Outcomes in an Adolescent Suicide Management Program(2019-03-15) Lau, Jenny Wong; Emslie, Graham; Stewart, Sunita M.; Kennard, Beth D.BACKGROUND: Insomnia is the symptom most strongly associated with suicide-related thoughts and behaviors in adolescents and young adults with diverse diagnoses, even after adjusting for psychiatric conditions like depression (Goldstein, 2008). However, there is little empirical evidence that demonstrates prospectively that sleep problems are in fact a risk factor for suicide attempts (Franklin et al. 2017). OBJECTIVE: This study examines the previously unexplored relationship between insomnia and suicidal relapse in youth enrolled in an outpatient suicide prevention program. METHODS: Data were obtained from clinical records of adolescents ages 12-17 enrolled in the Suicide Prevention and Resilience at Children's Intensive Outpatient program (SPARC IOP) from January 1, 2014 through March 1, 2016 (n = 206). Patients completed measures of depressive symptoms, insomnia, and suicide risk at entry and exit. The association between insomnia, exit suicide risk, and 6-month attempts was tested with multiple regression analyses. RESULTS: Patients were mainly female (79.1%; n = 163) with a primary diagnosis of depression (89.8%; n = 185). Depression, suicide risk, and insomnia scores decreased overall. Entry insomnia was associated with exit suicide risk (CHRT) after controlling for entry risk, age, sex, time in the program, and number of previous attempts. Patients with insomnia did not show a different rate of treatment response (β = 0.257, p > .10). Entry insomnia was also associated with suicide attempts within 6 months after exiting the program when controlling for age, sex, and previous attempts. When entry and exit risk were added to the model, the association between entry insomnia and attempts within 6 months lost significance while the association between exit risk and attempts at 6 months became significant. Thus, patients with higher insomnia scores at entry had higher suicide risk scores at exit, which increased the likelihood of a suicide attempt 6 months after the program. CONCLUSION: These findings suggest that insomnia is a distal variable in the pathway to risk for suicide attempts after discharge. Entry insomnia is associated with exit risk, which has a more proximal relationship with 6-month attempts. Direct management of insomnia symptoms could reduce suicide risk at program exit, which could then reduce the probability of a suicide attempt in the 6 months following discharge. These studies could ultimately lead to new therapeutic approaches for reducing suicide attempts by treating insomnia symptoms.