Publications

OBJECTIVES

To determine whether an educational intervention would improve depression assessment and appropriate referral. Secondary analyses tested whether referral led to depression improvement.

DESIGN

Training in the Assessment of Depression (TRIAD) was a three-group, nurse-randomized trial. Researchers interviewed randomly selected patients at baseline and 8 weeks.

SETTING

Three certified home healthcare agencies in Westchester County, New York.

PARTICIPANTS

Fifty-three medical/surgical nurses were randomized within agency to three intervention groups: full, minimal, or control. Research contact with nurses' patients (aged >65; N=477) yielded 256 (53.7%) enrolled subjects, 84 (17.6%) ineligibles, and 120 (25.2%) refusals; 233 of the 256 (87.1%) enrolled patients completed follow-up interviews.

INTERVENTION

Nurse training in clinically meaningful use of depression sections of Medicare's mandatory Outcome and Assessment Information Set (OASIS).

MEASUREMENTS

Nurse-assessed mood or anhedonia (OASIS) versus research assessments using the Structured Clinical Interview for Axis I Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Disorders (SCID); referrals for mental health evaluation (agency records), and depression severity (24-item Hamilton Depression Rating Scale; HDRS).

RESULTS

Referral rates for patients with (SCID) depressed mood or anhedonia (n=75) varied according to nurse group: 50.0% full intervention, 18.5% minimal, 21.4% control (P=.047). Rates for nondepressed patients (n=180) did not differ (4.9%, 2.0%, 5.8%, respectively; P=.60). In patients with major or minor depression (n=37), referral was associated with symptom improvement. Change in HDRS was 5 points greater in referred patients than others (P=.04). Concordance between OASIS and SCID did not differ between intervention groups.

CONCLUSION

TRIAD showed that training nurses to assess for depression using an approach developed in partnership with home healthcare agencies led to appropriate referral and care for depressed patients.

BACKGROUND

Segmentectomy or wedge resection along with brachytherapy delivered via a vicryl mesh implant imbedded with 125I is a novel therapeutic modality to treat early stage lung cancer. This modality is being evaluated in a large national prospective randomized trial (ACOSOG Z4032). There has been concern that this method exposes physicians and staff to unacceptable amounts of radiation. In this prospective study, we measured the exposure to health care professionals during such a procedure.

METHODS

Dosimetric readings using Special Microdosimeter thermoluminescent detectors (TLDs) (Landauer, Inc) were performed during 22 125I vicryl mesh implantations. Diodes were placed on the back of the each hand of the primary radiation oncologist and primary surgeon during the creation and implantation of the mesh. In addition, diodes were placed on the posterior shoulder of the patient to obtain a control reading.

RESULTS

Patients had 40-60 125I seeds placed. Median activity per seed was 0.511 milli Curie (mCi), with a median total activity implanted of 23.0 mCi. Median radiation dose to the radiation oncologist was 1 milli rem (mrem), and that to the surgeon was 2 mrem. Median dose to the control diode on the patient was a median radiation dose to the outside of the patient of 5.4 mrem/h.

CONCLUSIONS

There is very little radiation exposure to physicians and staff during a segmentectomy and 125I vicryl mesh implantation. This is a safe method of lung cancer treatment with respect to health care professionals, although the ALARA (As Low As Reasonably Achievable) principle should still be followed.

Ventricular tachycardia most often arises from the ventricular outflow tracts in patients with apparently structurally normal hearts, and is often termed idiopathic ventricular tachycardia. These tachycardias are characterized by a left bundle branch block, inferior axis QRS morphology, and a unique electropharmacologic profile. The choice of treatment is dictated by the severity of symptoms, and ranges from observation for asymptomatic patients, to antiarrhythmic agents for those who are mildly to moderately symptomatic (eg, palpitations), to catheter-based ablation for those with more troubling symptoms or those who develop tachycardia-mediated cardiomyopathy. Antiarrhythmic therapy can be effective for arrhythmia suppression, and radiofrequency ablation has a high success rate (> 90%) with few procedural complications. In general, ventricular outflow tract tachycardia has a favorable prognosis. Exclusion of arrhythmogenic right ventricular dysplasia/cardiomyopathy is important due to significant disparities in prognosis and treatment.