Survey of collaborative mental health providers in cystic fibrosis centers in the United States

Mental health care needs in cystic fibrosis: A scoping review

People with cystic fibrosis experience rates of anxiety and depression that are considerably higher than those of the general population. Research suggests low mental health functioning can lead to poor health outcomes and quality of life for this population. Consequently, recognition of the need for routine mental health screening and referral in cystic fibrosis care is increasing. Yet to date, less is known about the actual mental health care needs of people with cystic fibrosis. This scoping review sought to address this gap by examining the mental health care needs of adults and adolescents living with cystic fibrosis, and how are these needs are (or are not) being met. Findings suggest current efforts at mental health care provision do not adequately meet the needs of people with cystic fibrosis, highlighting the urgency of conducting high quality intervention research to support effective mental health care for this population.

Psychotropic medication use trends in a large pediatric and young adult solid organ transplant population

INTRODUCTION

This study describes psychotropic medication use in a pediatric and young adult solid organ transplant population.

METHODS

We conducted a retrospective review of the lifetime incidence of psychotropic medication use and associated characteristics in patients seen over a 6-year period at a large pediatric transplant center utilizing univariate and multivariate statistical analyses.

RESULTS

The lifetime incidence of psychotropic medication use was 36.5% in 393 patients. Transplant psychiatry provided psychopharmacological consultation to 21.9% of patients. Controlling for age and sex, there were significant associations between psychotropic use and thoracic organ disease (heart/lung) (AOR = 2.14; 95% CI: 1.2-3.8; P = 0.01), White race (P = 0.0002), histories of depressive/mood disorders (AOR = 3.68; 95% CI: 1.8-7.7; P = 0.0005), attention/learning disorders (AOR = 3.30; 95% CI: 1.6-6.9; P = 0.001), acute and post-traumatic stress disorders (AOR = 10.54; 95% CI: 2.6-42.8; P = 0.001), and experiencing bullying (AOR = 2.16; 95% CI: 1.03-4.55; P = 0.04). In unadjusted tests, significant associations were found between lifetime psychotropic usage and patient anxiety history (OR = 2.26; 95% CI: 1.5-3.5; P = 0.0002), end-of-life disease progression (OR = 3.04; 95% CI: 1.7-5.4; P = 0.0002), family psychiatric history (OR = 2.17; 95% CI: 1.4-3.4; P = 0.0007), and adherence concerns (OR = 2.67; 95% CI: 1.7-4.1; P < 0.0001).

DISCUSSION

The lifetime incidence of psychotropic medication use among pediatric and young adult transplant patients is substantial. Patients with thoracic organ disease, end-of-life illness, individual/family psychiatric histories, trauma, and bullying histories have particularly high rates. Integrating child psychiatry as part of pediatric transplant teams should be an important consideration for the care of these patients.

Bubbling and foaming assisted clearing of mucin plugs in microfluidic Y-junctions

Microfluidic Y-junctions were used to study mechanical mechanisms involved in pig gastric mucin (PGM) plug removal from within one of two bifurcation branches with 2-phase air and liquid flow. Water control experiments showed moderate plug removal due to shear from vortex formation in the blockage branch and suggest a PGM yield stress of 35Pa, as determined by computational fluid dynamics. Addition of hexadecyltrimethylammonium bromide (CTAB) surfactant improved clearing effectiveness due to bubbling in 1mm diameter channels and foaming in 500μm diameter channels. Plug removal mechanisms have been identified as vortex shear, bubble scouring, and then foam scouring as air flow rate is increased with constant liquid flow. The onset of bubbling and foaming is attributed to a flow regime transition from slug to slug-annular. Flow rates explored for 1mm channels are typically experienced by bronchioles in generations 8 and 9 of lungs. Results have implications on treatment of cystic fibrosis and other lung diseases.

Integrated Behavioral Health Care in Pediatric Subspecialty Clinics

Comorbid behavioral and physical health conditions are accompanied by troubling symptom burden, functional impairment, and treatment complexity. Pediatric subspecialty care clinics offer an opportunity for the implementation of integrated behavioral health (BH) care models that promote resiliency. This article reviews integrated BH care in oncology, palliative care, pain, neuropsychiatry, cystic fibrosis, and transplantation. Examples include integrated care mandates, standards of care, research, and quality improvement by child and adolescent psychiatrists (CAPs) and allied BH clinicians. The role of CAPs in integrated BH care in subspecialty care is explored, focusing on cost, resource use, financial support, and patient and provider satisfaction.