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These were reformulated and presented in a second round. Thirteen of these statements were accepted, none were rejected, and five statements needed to be reformulated and were presented in the third and final round of this Delphi study. selleck products In this final round, all statements were accepted.

Consensus was reached among professionals, patients, and informal caregivers in the Netherlands about essential and valuable components of nursing care for patients suffering from acute mania who are admitted to a closed psychiatric ward.

Consensus was reached among professionals, patients, and informal caregivers in the Netherlands about essential and valuable components of nursing care for patients suffering from acute mania who are admitted to a closed psychiatric ward.

Patients with somatic symptom disorders (SSD) are prevalent in primary care, urgent care, and emergency rooms and present with reduced quality of life, increased disability, and suicidality . Criteria for SSD include (1) somatic symptoms that cause distress and disrupt life; (2) concurrent physical illness with thoughts and feelings that are disproportionate to the seriousness of the illness; and (3) distress which is persistent and causes suffering. The frequency of SSD in the general population is 5% to 7%; however, in primary care, it is 5% to 35% . Because patients present with anxiety, depression, and/or pain, providers are flummoxed when diagnostic findings do not match symptom intensity.

The purpose of this project was to provide an intervention for patients with SSD and measure its effectiveness on their somatic symptoms.

This study provided a single-session, 30-minute psychoeducational intervention for patients to explain brain pathways for pain and the body's response to stress, including scientific benefits of exercise and healthy diet. Patients were asked questions using the motivational interviewing technique OARS (open-ended question, affirmation, reflection, summary) and were encouraged to talk about their concerns. The study used a pre- and post-intervention visual analogue scale and a self-reported Patient Health Questionnaire-15 both before and 3 weeks post-intervention.

Measurements showed significant symptom improvement immediately after the intervention with sustained improvement 3 weeks post-intervention.

This intervention demonstrates an effective treatment for this insidious illness, which plagues up to 35% of patients in primary care.

This intervention demonstrates an effective treatment for this insidious illness, which plagues up to 35% of patients in primary care.This study asks how much and why the productivity of advanced practice clinicians (APCs; nurse practitioners and physician assistants) varies across community health centers (CHCs), as measured in their marginal contribution to overall patient visits. We found APCs in the 90th percentile CHCs provide about 1,840 adjusted-visits per year, whereas APCs in the 10th percentile CHCs provide about 978 adjusted-visits per year. We interviewed leadership at 14 high APC and 16 low APC productivity CHCs to elicit organizational conditions that could explain the difference. Using content analysis and then qualitative comparative analysis, we found several important conditions were more common among high productivity CHCs, including scheduling APCs and physicians for the same number of visits, parity in terms of any financial incentives, and formal education programs for new APCs during onboarding/transition to practice.Background The prognostic significance of chronic kidney disease (CKD) in severe aortic stenosis is poorly understood and no studies have yet evaluated the effect of aortic-valve replacement (AVR) versus conservative management on long-term mortality by stage of CKD. Methods and Results We included 4119 patients with severe aortic stenosis. The population was divided into 4 groups according to the baseline estimated glomerular filtration rate no CKD, mild CKD, moderate CKD, and severe CKD. The 5-year survival rate was 71±1% for patients without CKD, 62±2% for those with mild CKD, 54±3% for those with moderate CKD, and 34±4% for those with severe CKD (P less then 0.001). By multivariable analysis, patients with moderate or severe CKD had a significantly higher risk of all-cause (hazard ratio [HR] [95% CI]=1.36 [1.08-1.71]; P=0.009 and HR [95% CI]=2.16 [1.67-2.79]; P less then 0.001, respectively) and cardiovascular mortality (HR [95% CI]=1.39 [1.03-1.88]; P=0.031 and HR [95% CI]=1.69 [1.18-2.41]; P=0.004, respectively) than patients without CKD. Despite more symptoms, AVR was less frequent in moderate (P=0.002) and severe CKD (P less then 0.001). AVR was associated with a marked reduction in all-cause and cardiovascular mortality versus conservative management for each CKD group (all P less then 0.001). The joint-test showed no interaction between AVR and CKD stages (P=0.676) indicating a nondifferentialeffect of AVR across stages of CKD. After propensity matching, AVR was still associated with substantially better survival for each CKD stage relative to conservative management (all P less then 0.0017). Conclusions In severe aortic stenosis, moderate and severe CKD are associated with increased mortality and decreased referral to AVR. AVR markedly reduces all-cause and cardiovascular mortality, regardless of the CKD stage. Therefore, CKD should not discourage physicians from considering AVR.Nostalgia, a sentimental longing for one's past, can serve as a resource for individuals coping with discomforting experiences. The experience of bereavement poses psychological and physical risks. In a longitudinal study, we examined whether dispositional nostalgia predicted reductions in distress associated with the death of a loved one. Undergraduate students (N = 133) provided information regarding their loss (time elapsed since loss, expectedness) and levels of initial grief, nostalgia, and distress (hyperarousal, intrusion, avoidance) at three time points over a one-month period (Times 2 and 3 occurred one week and one month after the initial session, respectively). Individuals experiencing higher nostalgia reported a decrease in intrusive thoughts across time, whereas those experiencing lower nostalgia reported no change in intrusive thoughts across time. Hyperarousal (physical symptoms, negative feelings) decreased across time among individuals with higher initial grief who experienced greater nostalgia, but increased across time among those with higher initial grief who experienced lesser nostalgia.