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Brody BD, Park N, Christian A, Shaffer CW, Smetana R, Kotbi N, Russ MJ, Kanellopoulos D. Ketamine for major depressive disorder during an inpatient psychiatric admission: Effectiveness, adverse events, and lessons learned. J Affect Disord 2024; 351:293-298. [PMID: 38286230 DOI: 10.1016/j.jad.2024.01.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 01/31/2024]
Abstract
OBJECTIVE Most studies examining the efficacy of ketamine for Major Depressive Disorder (MDD) have been conducted in outpatient or mixed inpatient/outpatient settings. Less is known about effectiveness and tolerability of ketamine for psychiatrically hospitalized patients. Efficacy and tolerability data from a naturalistic sample of acute inpatients may help inform institutions considering ketamine therapy for inpatient services. METHODS We performed a retrospective chart review of inpatients with non-psychotic MDD treated during the initial 3 years of a ketamine infusion program. Treatment effectiveness was defined using change in Montgomery Asberg Depression Rating Scale (MADRS) scores over five infusions. MDD treatment response was defined by a 50 % reduction of MADRS score, and remission was defined as MADRS score ≤ 10 at any point during the treatment. We also report the frequency of adverse events. RESULTS 41 patients with MDD were treated and had outcome data. 19 patients (46.5 %) met criteria for response and 15 patients (26.5 %) met criteria for remission during treatment. Four patients (10 %) had adverse psychological or behavioral outcomes. LIMITATIONS MADRS scales were administered by psychiatrists, psychologists, and trainees in each discipline who did not undergo standardized training in scale administration. Consistent data regarding the race/ethnicity of the patients was not available. CONCLUSION Twice weekly racemic ketamine infusion is an effective treatment option for patients hospitalized with MDD. Unmonitored or at home ketamine therapy may pose substantial risks.
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Affiliation(s)
- Benjamin D Brody
- Weill Cornell Medicine/Psychiatry, New York and White Plains, NY, United States of America.
| | - Nana Park
- New York Presbyterian Hospital, United States of America
| | | | - Charles W Shaffer
- Weill Cornell Medicine/Psychiatry, New York and White Plains, NY, United States of America
| | - Roy Smetana
- Weill Cornell Medicine/Psychiatry, New York and White Plains, NY, United States of America
| | - Nabil Kotbi
- Weill Cornell Medicine/Psychiatry, New York and White Plains, NY, United States of America
| | - Mark J Russ
- Silver Hill Hospital, United States of America
| | - Dora Kanellopoulos
- Weill Cornell Medicine/Psychiatry, New York and White Plains, NY, United States of America
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Shaffer CW, Wyka K, Ewing J, Russ MJ, Kanellopoulos D, Brody BD. Low COVID-19 Vaccination Rates Among Psychiatric Inpatients: Implications for Institutional Settings and Outreach Efforts. Psychiatr Serv 2023; 74:320-323. [PMID: 36065578 DOI: 10.1176/appi.ps.20220222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study sought to determine COVID-19 vaccination rates for individuals with serious mental illness admitted to a large health system in New York State. METHODS Vaccination rates among 12,714 patients admitted to psychiatric units and to medical and surgical units were compared between April 6, 2021, and September 30, 2021. RESULTS Only 40% (N=416 of 1,029) of patients admitted to psychiatric services had at least one COVID-19 vaccination, whereas 64.4% (7,523 of 11,685) of patients admitted to medical and surgical services had at least one vaccination. After adjustment for differences in key demographic and clinical characteristics, patients admitted to psychiatric services had a significantly lower likelihood of vaccination during the study period (risk ratio=0.78, 95% confidence interval=0.73-0.85, p<0.001). Black psychiatric patients had the lowest vaccination rate (28%). CONCLUSIONS Psychiatric patients with acute illness had low COVID-19 vaccination rates. Targeted outreach for COVID-19 vaccination is necessary to reach this population.
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Affiliation(s)
- Charles W Shaffer
- Department of Psychiatry, Weill Cornell Medicine, New York City (Shaffer, Wyka, Russ, Kanellopoulos, Brody); Graduate School of Public Health and Health Policy, City University of New York, New York City (Wyka); New York-Presbyterian Hospital, New York City (Ewing)
| | - Katarzyna Wyka
- Department of Psychiatry, Weill Cornell Medicine, New York City (Shaffer, Wyka, Russ, Kanellopoulos, Brody); Graduate School of Public Health and Health Policy, City University of New York, New York City (Wyka); New York-Presbyterian Hospital, New York City (Ewing)
| | - Julie Ewing
- Department of Psychiatry, Weill Cornell Medicine, New York City (Shaffer, Wyka, Russ, Kanellopoulos, Brody); Graduate School of Public Health and Health Policy, City University of New York, New York City (Wyka); New York-Presbyterian Hospital, New York City (Ewing)
| | - Mark J Russ
- Department of Psychiatry, Weill Cornell Medicine, New York City (Shaffer, Wyka, Russ, Kanellopoulos, Brody); Graduate School of Public Health and Health Policy, City University of New York, New York City (Wyka); New York-Presbyterian Hospital, New York City (Ewing)
| | - Dora Kanellopoulos
- Department of Psychiatry, Weill Cornell Medicine, New York City (Shaffer, Wyka, Russ, Kanellopoulos, Brody); Graduate School of Public Health and Health Policy, City University of New York, New York City (Wyka); New York-Presbyterian Hospital, New York City (Ewing)
| | - Benjamin D Brody
- Department of Psychiatry, Weill Cornell Medicine, New York City (Shaffer, Wyka, Russ, Kanellopoulos, Brody); Graduate School of Public Health and Health Policy, City University of New York, New York City (Wyka); New York-Presbyterian Hospital, New York City (Ewing)
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Kurusz M, Shaffer CW, Christman EW, Tyers GF. Runaway pump head: new cause of gas embolism during cardiopulmonary bypass. J Thorac Cardiovasc Surg 1979; 77:792-5. [PMID: 431117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Massive gas embolism was narrowly avoided during a recent case of cardiopulmonary bypass for aortic valve replacement. Cause of the mishap was an arterial pump head that had rapidly accelerated spontaneously, emptying the oxygenator of blood within seconds. No gas entered the patient's vascular system, but a period of circulatory arrest was required in order to purge the extracorporeal circuit of gas and to re-establish blood flow. Only an instantaneous response by the perfusionist prevented massive gas embolism.
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Abstract
Coronary artery anomalies in tetralogy of Fallot have often compromised surgical repair and imposed an increased mortality rate. Thus accidental division of the anterior descending coronary artery crossing the right outflow tract has previously usually resulted in death. The case is presented of a 13-year-old boy with tetralogy of Fallot in whom the anomalous left anterior descending coronary artery was divided. The blood supply to the left anterior descending artery was successfully restored using a reversed saphenous vein graft.
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Tyers GF, Brownlee RR, Hughes HC, Shaffer CW, Williams EH, Kao RL. Myocardial stimulation impedance: the effects of electrode, physiological, and stimulus variables. Ann Thorac Surg 1979; 27:63-9. [PMID: 453959 DOI: 10.1016/s0003-4975(10)62974-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
With exposed metal at the electrode tissue interface (8 mm2, 28 mm2, 57 mm2), myocardial threshold stimulation impedance increased as pulse duration was lengthened, with left ventricular intramyocardial stimulation, and with the smaller surface area electrode. An 0.5 mm2 differential-current-density electrode, which eliminated direct metal-to-tissue contact at the electrode-myocardial interface, was associated with notably higher impedances than each of the three metal tip electrodes and did not show increasing impedance levels with changes in pulse duration, confirming the minimization of polarization energy losses with this device. The majority of electrode, electrode tissue interface, and myocardial variables that are characterized by high threshold stimulation impedance are associated with low threshold energy requirements for pacing and reduced pacemaker power source drain. No accurate information about sensing impedances can be derived from current knowledge of pacing impedance.
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Williams EH, Tyers GF, Shaffer CW. Symptomatic deep venous thrombosis of the arm associated with permanent transvenous pacing electrodes. Chest 1978; 73:613-5. [PMID: 648213 DOI: 10.1378/chest.73.5.613] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
From October 1970 to May 1977, a total of 212 pacemakers were implanted at the Milton S. Hershey Medical Center of Pennsylvania State University, Hershey. During this period, we encountered five patients with symptomatic thrombosis of the subclavian vein, a rate for this complication of approximately 2 percent. Although this complication was reported only rarely prior to 1976, we believe that symptomatic subclavian thrombosis after insertion of a transvenous pacemaker electrode occurs more frequently than previously suspected. The etiology, pathogenesis, and treatment of this interesting condition are discussed.
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Williams DR, Tyers GF, Williams EH, Kurusz M, Shaffer CW, Pierce WS, Waldhausen JA. Similarity of clinical and laboratory results obtained with microporous teflon membrane oxygenator and bubble-film hybrid oxygenator. Ann Thorac Surg 1978; 25:30-5. [PMID: 619809 DOI: 10.1016/s0003-4975(10)63482-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
For 80 elective clinical cardiopulmonary bypasses we alternately used either a commercial microporous Teflon membrane oxygenator or a commercial hybrid bubble-film oxygenator. Setup time was a little longer with the membrane unit (20 minutes), but priming volume (2,250 ml) was the same. No problems were encountered with the hybrid oxygenator. However, despite our monitoring of additional variables, including shim and inlet pressure and recirculation flow, gas exchange abnormalities were encountered in 5 patients on whom the membrane oxygenator was used; in 4 of these cases the abnormalities were encountered prior to our recognition of the potential for occasional internal shunting with this device. There were no hospital deaths. When the two groups, matched except for oxygenator selection, were compared, there were no significant differences clinically or hematologically. For cardiopulmonary bypass of 2 hours or less, both oxygenators studied are definite improvements over previous silicone membrane and high-gas-flow bubble oxygenators. However, lower cost and reduced complexity favor the hybrid oxygenator.
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