Maldonadoallred7316

Introduction Recent studies have revealed a possible link between heart rate variability (HRV) and major depressive disorder (MDD), with decreased HRV in MDD compared with healthy subjects. Corrected Q-T interval (QTc) has been suggested to represent an indirect estimate of HRV, as QTc length is inversely correlated to parasympathetic activity in healthy subjects. This retrospective study assessed the ability of QTc length in predicting response to vagus nerve stimulation (VNS) treatment in refractory depression. Methods We measured QTc length in 19 patients suffering from refractory depression, selected to be implanted with VNS. Correlations were calculated between baseline QTc (preimplantation) and long-term mood response. Results Nineteen patients selected for VNS surgery were included in the study. Baseline 28-item Hamilton Depression Rating Scale scores were 28.5 ± 6.8 and decreased to 15.1 ± 9.5 at 12 months and 12.4 ± 10.4 at 24 months post-VNS. Among the 19 patients, 53% (10) were responders and 26% (5) were in remission at 12 months. Pretreatment QTc averaged 425.5 ± 22.0. Patients with longer baseline QTc displayed larger improvement, with a significant correlation between mood and QTc values after 12 months (r(18) = -0.526, P = 0.02) and also after 24 months of VNS therapy (r(17) = -0.573, P = 0.016). Conclusions The presented analysis showed that increased QTc in patients with MDD might be used as a baseline biomarker for depressive episodes that might respond preferentially to VNS. The link between cardiovagal activity in depression and response to VNS treatment requires further investigation in larger cohorts and randomized controlled trials.Purpose/objectives The purpose of this project was to develop, implement, and evaluate an educational program and a serious illness (SI) protocol for a case management team of nurses and social workers to achieve the following (1) utilize an SI protocol to identify patients with SI; (2) utilize a Serious Illness Structured Communication Guide to elicit these patients' goals and preferences for SI care; and (3) document in the electronic medical record the patients' elicited values and goals using a structured SI documentation template. Primary practice setting and sample Seventeen nurse and 3 social work case managers in an Accountable Care Organization (ACO) in a large health system in a western suburb of Chicago participated in this project. The practice setting was the primary care clinics associated with the health system. Patients eligible for the project met the SI criteria and were part of the organization's ACO or Bundle Payment for Care Improvement program. Methodology Twenty members of the case manaucational program pretest scores ranged from 46.2% to 84.6%, with posttest scores ranging from 69.2% to 100%. A paired-samples t test demonstrated a statistically significant increase in posttest scores. Baseline confidence scores ranged from 1 to 4, with postproject confidence scores ranging from 2 to 4. A paired-samples t test demonstrated a statistically significant increase in confidence.Serious Illness Protocol The case managers correctly identified 92% of patients who met the established SI identification criteria for this project. In 91.8% of cases, the case managers conducted an SI conversation in adherence to the protocol. In 76% of the cases, documentation about the SI conversation was completed in accordance with the protocol.Purpose/objectives Identifying risk factors associated with caregiver stress and suggesting methods for systematic caregiver screening for caregiver strain, depression, and anxiety. Primary practice setting Emergency department, primary care, and other health care settings. Findings/conclusions Caregiver stress can lead to multiple negative outcomes including declines in physical health, increased mental health concerns, and overall decreased quality of life. Caregiver stress also leads to increased financial costs to the person, family, and health care systems, making it a public health issue. Recognizing caregiver stress is the initial step to identifying those in need of support and to providing quality care. Fortunately, caregiver stress can be prevented or reduced using a culturally competent multidimensional approach to addressing social determinants of health and unmet physical, psychological, and social/emotional needs of caregivers. Implications for case management Case management plays a critical role in assessing, educating, advocating, creating care plans, and advocating for both the caregiver and the care recipient.Purpose The purpose of the national role and function study was to identify the essential activities and necessary knowledge areas for effective professional case management practice from the perspective of those directly involved. The study also aimed to inform the relevance and currency of the blueprint for the case management certification examination. Primary practice settings The national study covered the diverse case management practices and/or work settings across the full continuum of health and human services and numerous professional disciplines. Methodology and sample This cross-sectional descriptive study used the practice analysis method and online survey research design. It employed a purposive sample of 2,810 certified and not yet certified case managers who responded to an open participation link made available as an online survey. The final study sample supported the conduct of meaningful statistical analyses including multiple subgroup comparisons. Results The study identified the common acly as a function that is separate from that of the case manager. Implications for case management practice The study has identified the essential activities and knowledge areas of case management practice at both the micro and macro levels. These findings represent the substantive evidence of practice, keeping the CCM credentialing examination evidence-based and maintaining its validity for evaluating the competency of professional case managers. They have also documented the evolution of the practice over the past 5 years. check details Moreover, the findings may inform the development of programs and curricula for the training and advancement of case managers. The study instrument also is beneficial for use in further research into professional case management practice.