1. NSAIDs are used in many different forms of arthritis a. Reduce pain i. Analgesic as narcotics (in therapeutic doses) in acute pain b. Decrease gelling c. Improve function d. Anti-inflammatory i. Achieved by a number of mechanisms e. Antipyretic agents i. Inhibit prostaglandins in the CNS which reduces fever f. Antiplatelet i. Most decrease platelet aggregation by preventing thromboxane A2 production ii. Prevents the first step in coagulation

Introduction

We investigated the feasibility to proactively stimulate subsequent closure of a patent foramen ovale (PFO) by injuring (mechanical trauma or radiofrequency [RF] energy) the opposing surfaces of the septum primum (SP) and septum secundum (SS).

Methods

1. Mechanical Injury: The interatrial septum of patients who underwent multiple left atrial (LA) ablations over 6 years, where a PFO was used for LA access, were examined. Patients whose PFO was absent during a later procedure were identified. Eleven patients with LA accessed via a PFO also underwent subsequent LA procedures. 2. Ablation: Ten patients undergoing ablation for drug-resistant atrial fibrillation (AF), who also had a PFO, were studied. RF delivery was extended along the upper SP. Transthoracic echocardiogram (TTE) bubble study was repeated after 3 months.

Results

1. Mechanical Injury: Seven were male with a mean age of 58.3 ± 9.99. LA size was 42.73 ± 3.52 mm. The mean left ventricular ejection fraction (EF) was 62 ± 7.4%. During the repeat procedure, in 4 patients, the PFO could not be visualized and the fossa ovalis (FO) was punctured. The fourth patient had three procedures. During the second procedure the PFO was accessed, but with difficulty. During the third procedure, it was no longer present. All four patients had subsequent TTE showing no PFO. 2. Ablation: Seven were male with a mean age of 61.1 ± 9.8 years. The mean EF and LA diameters were 55 ± 5% and 4.4 ± 0.8 cm respectively. The mean RF time was 5.4 ± 2.2 min. At 3 months, 9 patients out of 10 showed no interatrial communication.

Conclusion

Injury of tunnel surfaces of the SP and SS by mechanical trauma or ablation can fuse the foramen ovale.

In 2009, Walter Reed began offering a complimentary service dog training therapy program (SDTTP). This program is offered as part of a rehabilitation treatment for patients with posttraumatic stress disorder (PTSD). SDTTP offers a structured program teaching patients with PTSD to train mobility service dogs for fellow wounded warriors. The SDTTP focuses on reducing the three main symptoms of PTSD: reexperiencing, avoidance/numbing, increased arousal, while also improving social competence and family dynamics. Volunteers for the SDTTP are taught service dog training skills. These skills encompass a wide range of standard PTSD therapies such as cognitive behavior therapy and prolonged exposure. This chapter discusses two case studies of patients in treatment at Walter Reed National Military Medical Center (WRNMMC) who participated in the SDTTP. These accounts are compiled from excerpts obtained from medical documentation, occupational therapy (OT), recreational therapy (RT) clinical notes, and service dog instructor (SDI) observations. Both patients voluntarily participated in interview sessions at WRNMMC in December 2014 to share their recollections and perceptions of the program and how it affected them. Together, these accounts offer promising evidence supporting clinically based service dog training program as a safe, popular, and effective complementary treatment for PTSD.

Older adults present with a complex array of medical disorders that present with or worsen comorbid psychiatric disorders. Additionally the treatment of these disorders can result in or worsen the comorbid psychiatric disorders. Poor clinical awareness, lack of assessment tools specifically designed for use among older adults, and the confusion in presentation of these medical disorders can result in under- or misdiagnosis of these conditions. Early diagnosis and prompt interventions can minimize the adverse outcomes from these medical disorders and improve the quality of life of older adults.

Background

Wolfram Syndrome (WFS:OMIM 222300) is an autosomal recessive, progressive, neurologic and endocrinologic degenerative disorder caused by mutations in the WFS1 gene, encoding the endoplasmic reticulum (ER) protein wolframin, thought to be involved in the regulation of ER stress. This paper reports a cross section of data from the Washington University WFS Research Clinic, a longitudinal study to collect detailed phenotypic data on a group of young subjects in preparation for studies of therapeutic interventions.

Methods

Eighteen subjects (ages 5.9–25.8, mean 14.2 years) with genetically confirmed WFS were identified through the Washington University International Wolfram Registry. Examinations included: general medical, neurologic, ophthalmologic, audiologic, vestibular, and urologic exams, cognitive testing and neuroimaging.

Results

Seventeen (94%) had diabetes mellitus with the average age of diabetes onset of 6.3 ± 3.5 years. Diabetes insipidus was diagnosed in 13 (72%) at an average age of 10.6 ± 3.3 years. Seventeen (94%) had optic disc pallor and defects in color vision, 14 (78%) had hearing loss and 13 (72%) had olfactory defects, eight (44%) had impaired vibration sensation. Enuresis was reported by four (22%) and nocturia by three (17%). Of the 11 tested for bladder emptying, five (45%) had elevated post-void residual bladder volume.

Conclusions

WFS causes multiple endocrine and neurologic deficits detectable on exam, even early in the course of the disease. Defects in olfaction have been underappreciated. The proposed mechanism of these deficits in WFS is ER stress-induced damage to neuronal and hormone-producing cells. This group of subjects with detailed clinical phenotyping provides a pool for testing proposed treatments for ER stress. Longitudinal follow-up is necessary for establishing the natural history and identifying potential biomarkers of progression.

Purpose

The aim of this study is to investigate the psychometrics of the Patient-Reported Outcomes Measurement Information System self-efficacy for managing daily activities item bank.

Methods

The item pool was field tested on a sample of 1087 participants via internet (n = 250) and in-clinic (n = 837) surveys. All participants reported having at least one chronic health condition. The 35 item pool was investigated for dimensionality (confirmatory factor analyses, CFA and exploratory factor analysis, EFA), item-total correlations, local independence, precision, and differential item functioning (DIF) across gender, race, ethnicity, age groups, data collection modes, and neurological chronic conditions (McFadden Pseudo R² less than 10 %).

Results

The item pool met two of the four CFA fit criteria (CFI = 0.952 and SRMR = 0.07). EFA analysis found a dominant first factor (eigenvalue = 24.34) and the ratio of first to second eigenvalue was 12.4. The item pool demonstrated good item-total correlations (0.59–0.85) and acceptable internal consistency (Cronbach’s alpha = 0.97). The item pool maintained its precision (reliability over 0.90) across a wide range of theta (3.70), and there was no significant DIF.

Conclusion

The findings indicated the item pool has sound psychometric properties and the test items are eligible for development of computerized adaptive testing and short forms.

Chapter 9 provides an overview of health problems facing runaway and homeless young people. Youth who are on the streets often have difficulty accessing health care and have an increased probability of developing mental, physical health, and social difficulties. Runaway young people may have an increased probability of suffering from problems such as pneumonia, scabies, depressive symptoms, post-traumatic stress disorder, conduct disorder, prostitution, and substance use. This chapter discusses the factors that increase the likelihood that homeless and runaway young people will develop health problems. This chapter evaluates the degree to which homeless and runaway young people who are victims of human trafficking or engage in other risky behaviors such as survival sex may have a higher probability of suffering victimization and poor health outcomes such as sexually transmitted infections (STIs), including human immune virus (HIV)/acquired immunodeficiency syndrome (AIDS). Moreover, this chapter assesses the degree to which runaway and homeless youth who lack shelter and access to healthy food may face a greater likelihood of having food insecurity and related health problems. This chapter assesses the extent to which runaway and homeless youth suffer impaired functioning as a result of their health difficulties. In this chapter, the health status and level of impairment of adults who were former runaways are presented.

Background

Most research on the health impacts of intimate partner violence (IPV) and child abuse has been conducted in Western countries and may not be generalizable to women living in different contexts, such as Saudi Arabia. Chronic pain, a disabling health issue associated with experiences of both child abuse and IPV among women, negatively impacts women’s well-being, quality of life, and level of functioning. Yet, the psychosocial mechanisms that explain how abuse relates to chronic pain are poorly understood. We developed and tested a theoretical model that explains how both IPV and child abuse are related to chronic pain.

Methods

We recruited a convenience sample of 299 Saudi women, who had experienced IPV in the past 12 months, from nine primary health care centers in Saudi Arabia between June and August 2015. Women completed a structured interview comprised of self-report measures of IPV, child abuse, PTSD, depressive symptoms, chronic pain, and social support. Using Structural equation modeling (SEM), we analyzed the proposed model twice with different mental health indicators as mediators: PTSD symptoms (Model 1) and depressive symptoms (Model 2).

Results

Both models were found to fit the data, accounting for 31.6% (Model 1) and 32.4% (Model 2) of the variance in chronic pain severity. In both models, mental health problems (PTSD and depressive symptoms) fully mediated the relationship between severity of IPV and child abuse and chronic pain severity. Perceived family support partially mediated the relationship between abuse severity and depressive symptoms.

Conclusions

These results underscore the significance of considering lifetime abuse, women’s mental health (depressive and PTSD symptoms) and their social resources in chronic pain management and treatment.

Nephrolithiasis is a prevalent and costly condition with high recurrence rate. A medical evaluation to identify abnormalities responsible for nephrolithiasis and guide subsequent therapy has been advocated to reduce the risk of stone recurrence. The evaluation of kidney stone formers generally comprises an extensive medical history to identify metabolic, environmental, dietary, and/or genetic factors contributing to stone formation. Imaging studies are utilized to evaluate and follow stone burden. Laboratory studies including stone composition analysis and serum and urinary chemistries are commonly obtained to further assess for any underlying systemic disorders, to detect environmental and metabolic processes contributing to stone disease, and to guide initial and follow-up dietary and pharmacological therapy. The nature and extent of such an evaluation is discussed in this review article.