poster presented at the ddw 2014
DESCRIPTION
Abstract by Dr. RamirezEight-week community based program is associated with at least some improvement of depression in the vast majority of individuals with hepatitis CBackgroundHepatitis C positivity has been associated with a depressed mood and major depression. Some patients would like non-pharmacological methods to help them with their depression. Lifestyle interventions have had success in the depressed. We are reporting on how such education program helped individuals with hepatitis C.MethodsThe program was developed by the Nedley Clinic in Ardmore, Oklahoma, USA. This medical clinic trained and certified lay and professional people around the world in 3 continents. The focus of the program is educational and it does not create a doctor-patient relationship. Recruitment is done by for example radio, TV, handouts, newspapers and word of mouth. Those who chose to participate met once a week for 8 weeks for a 2 hour program. It consisted of a 45 minute DVD presentation by a physician experienced in the treatment of depression and a facilitated small group discussion together with weekly practical assignments. The program was available in Spanish and English. The previously validated Nedley Depression Recovery Program Assessment Test (registration TX 7-398-022) was used. It assessed depression level based on DSM-5 [The Diagnostic and Statistical Manual of Mental Disorders Volume 5] criteria, demographics and hepatitis C positivity. No questions were asked about individuals' treatment of hepatitis C or depression. The depression was classified according to DSM-5 into 4 categories as none (0-6), mild (7-10), moderate (11-19) or severe (20 or more). The progress was quantified on the category they finished in. A questionnaire was administered at baseline and completion. They were taught various healthy lifestyle habits like nutrition, exercise, rest, bright light, sleep, avoiding negative thoughts among other things.ResultsOf 4271 participants that finished the program, 40 (from USA, Canada, New Zealand and Australia) reported to have hepatitis C. Average age was 55 (SD 10), 65% females, 92% Caucasian. Baseline DSM-5 depression score had a mean of 15 points (SD 5), which corresponds to moderate depression. Table 1 shows the number of individuals in each category at baseline and at completion.At baseline 93% of the hepatitis C participants had some degree of depression, most of them of moderate or severe degree. Among those with severe or mild depression 100% improved at least one category. Among those with moderate depression 78% improved at least one category and another 17% showed some improvement. Only one showed no improvement. No one deteriorated. ConclusionThe 8-week depression recovery program was safe and was associated with at least some degree of improvement in the vast majority (97%). In order to see if it was the cause of the improvement it needs to be compared to a control group that does not participate. It also needs to be evaluated if the improvement will last by doing a long-term follow-up study.TRANSCRIPT
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50,000
Community Hospital Ardmore, Oklahoma
Snorri Olafsson, MD, PHD, MPH
Francisco E. Ramirez, MD
Neil Nedley, Md
DAVID LIVELY, RNA Change in Anesthesia Protocol for GI Endoscopic Procedures Decreased the Workload of a GI Lab
Background
The GI lab in a community hospital in the small town of Ardmore, Okla-homa, was one of the few places in America where registered nurses, under the supervision of an endos-copist, have been administering propofol in approximately 50,000 GI procedures without an anesthe-siologist since 1994.
At the end of 2012 a change in hos-pital policy required an anesthesiolo-gist to administer the anesthesia during all GI procedures.
Methods
Using the hospital database and the records of the billing department we quantified the number of procedures and their cost during 2011, 2012 and 2013 to see the effect of the policy change. The same number of endos-copists worked all years and were available equally. There was no lack of referrals for endoscopy with a steady waiting list of 2-3 weeks. Our lab is almost the only center doing endoscopies in our area.
Results Conclusion
In the GI lab, during 2011, 1632 EGDs and 2176 colonoscopies were done, a total of 3808 procedures.During 2012, 1668 EGDs and 2042 colonoscopies were done, a total of 3710 procedures. During 2013, 1514 EGDs and 1797 colonoscopies were done, a total of 3211 proce-dures. The percentage decrease from 2013 to 2012 being 9% for EGDs and 12% for colonoscopies a total decrease of 11%, from 2013 to 2011 being 7% for EGDs and 17% for colonoscopies a total decrease of 13%.
The anesthesia reimbursement added a cost of at least $150.20 (Medicare reimbursement) per endo-scopic procedure after the change in policy.
In the GI lab, during 2011, 1632 EGDs and 2176 colonoscopies were done, a total of 3808 procedures.
During 2012, 1668 EGDs and 2042 colonoscopies were done, a total of 3710 procedures. During 2013, 1514 EGDs and 1797 colonoscopies were done, a total of 3211 procedures. The percentage decrease from 2013 to 2012 being 9% for EGDs and 12% for colonoscopies a total decrease of 11%, from 2013 to 2011 being 7% for EGDs and 17% for colonoscopies a total decrease of 13%.
The anesthesia reimbursement added a cost of at least $150.20 (Medicare re-imbursement) per endoscopic proce-dure after the change in policy.