Posttraumatic stress disorder among mothers of pediatric cancer survivors: diagnosis, comorbidity, and utility of the PTSD checklist as a screening instrument. Sensitivity and Specificity of the PTSD Checklist in Detecting PTSD in Female Veterans in Primary Care Psychometric Properties of the PTSD Checklist—Civilian Version Validation of the PTSD checklist in an HMO sample of women. The impact of PTSD on pain experience in persons with HIV/AIDS Randomized Effectiveness Trial of a Brief Course of Acupuncture for Posttraumatic Stress Disorder A Randomized Stepped Care Intervention Trial Targeting Posttraumatic Stress Disorder for Surgically Hospitalized Injury Survivors CAM and energy psychology techniques remediate PTSD symptoms in veterans and spouses. A Systematic Review of the Efficacy of Creative Arts Therapies in the Treatment of Adults With PTSD PTSD symptom reduction with mindfulness-based stretching and deep breathing exercise: randomized controlled clinical trial of efficacy. Systematic Reviews of Diagnostic Test Accuracy Assessing risk for violence among male and female civil psychiatric patients: the HCR-20, PCL:SV, and VSC. Effect of Group vs Individual Cognitive Processing Therapy in Active-Duty Military Seeking Treatment for Posttraumatic Stress Disorder: A Randomized Clinical Trial Shoulder disorders: a state-of-the-art review The quality of reporting of diagnostic accuracy studies in glaucoma using the Heidelberg retina tomograph. EFT (Emotional Freedom Techniques) and Resiliency in Veterans at Risk for PTSD: A Randomized Controlled Trial. Hysterosalpingosonography for diagnosing tubal occlusion in subfertile women: a systematic review protocol Delivery of self training and education for stressful situations (DESTRESS-PC): a randomized trial of nurse assisted online self-management for PTSD in primary care. Reduction of PTSD Symptoms With Pre-Reactivation Propranolol Therapy: A Randomized Controlled Trial. Predictive Validity of the Psychopathy Checklist: Screening Version for Intramural Behaviour in Violent Offenders—A Prospective Study at a Secure Psychiatric Hospital in Germany Effectiveness of cognitive-behavioral trauma treatment for incarcerated women with mental illnesses and substance abuse disorders. Psychopathy Checklist Score Predicts Negative Events during the Sentences of Prisoners with Hare Psychopathy: A Prospective Study at a German Prison Exercise augmentation compared to usual care for Post Traumatic Stress Disorder: A Randomised Controlled Trial (The REAP study: Randomised Exercise Augmentation for PTSD)
OBJECTIVE To examine posttraumatic stress disorder ( PTSD ) in mothers of survivors of childhood cancer . Comorbidity of anxiety and depressive disorders , prevalence of sub clinical PTSD , and the utility of a self-report measure as a screening instrument for PTSD were also investigated . METHOD Mothers ( n = 65 ) completed a question naire self-report PTSD checklist ( PCL-C ) .  Mothers were administered several modules of the SCID : nonpatient edition by telephone , including the PTSD , Generalized Anxiety , and Major Depressive Disorder modules . RESULTS We diagnosed 6.2 % of the sample with current PTSD . An additional 20 % had sub clinical PTSD . One of four mothers with PTSD diagnoses had a comorbid diagnosis of an anxiety and depressive disorder . The PCL-C evidence d diagnostic utility as a screening instrument . However , a moderate number of false-positives would result if the recommended cut-off on the instrument was used . CONCLUSIONS The PCL-C had diagnostic utility in screening mothers of childhood cancer survivors . The presence of comorbid diagnoses such as anxiety and depression should be examined PTSD affects a substantial number of women in medical setting s and is associated with significant distress and impairment . There are effective methods of treating trauma-related distress , but a minority seek such care . Thus , primary care is an important setting in which to identify individuals with PTSD . We sent question naires , including the  PTSD Checklist — Civilian Version ( PCL-C )  , to 419 female veterans who were seen in our primary care clinic in 1998 ; 56 % ( N = 221 ) returned the measures . A r and om subset ( n = 49 ) was interviewed to establish psychiatric diagnoses . The results provide qualified support for the use of the PCL-C total score with a lowered cutoff score as a screening measure for PTSD in female veterans in primary care We examined the psychometric properties of the  PTSD Checklist ( PCL ) , a self-report instrument design ed to assess symptoms of posttraumatic stress disorder . Three hundred ninety-two participants recruited in a university setting completed the PCL in addition to several well-established self-report instruments design ed to assess various forms of psychopathology ( e.g. , depression , general anxiety , PTSD ) . Ninety participants returned for readministration of selected measures . Findings provided support for psychometric properties of the PCL  , including internal consistency , test – retest reliability , convergent validity , and discriminant validity . Additional strengths of the PCL are discussed Although Post-traumatic Stress Disorder ( PTSD ) is common among patients seeking care at medical clinics , little is known about the performance of screening instruments for this disorder in these setting s. Previous studies of acute trauma population s using the  PTSD Checklist ( PCL )  have suggested that scores of 45 - 50 provide the best discrimination between cases and noncases . We gave the PCL  to 1,225 r and omly selected women enrolled in an HMO . After interviewing a sample of 261 of these women using a structured , clinician-administered PTSD interview , we compared the results of the PCL to the clinician interviews over a range of possible cut scores using Receiver Operating Characteristic analysis . The optimum balance of sensitivity and specificity for this population was a score of 30 , yielding a sensitivity of.82 and specificity of.76 . The positive and negative likelihood ratios for this cut score were 3.40 and 0.24 , respectively . By comparison , the use of 45 as a cut score would result in very low sensitivity ( .36 ) in this setting . The lower cut score found in this study may indicate that the use of previously published cut scores of 45 - 50 may not optimize the function of the PCL as a screening tool outside of acute trauma setting s due to an unacceptably high number of false negative cases & NA ; Pain is a common and pervasive symptom for persons infected with the human immunodeficiency virus ( HIV ) . Individuals with persistent pain are known to be at heightened risk for posttraumatic stress disorder ( PTSD ) , an anxiety disorder that manifests itself following exposure to a traumatic event . Moreover , research suggests that patients with persistent pain who develop PTSD often experience greater pain intensity and pain‐related disability than those who do not develop PTSD . The purpose of this study was to assess the relation of PTSD to pain intensity and pain‐related interference in HIV‐infected persons suffering from persistent pain . Study participants included 145 ambulatory persons living with HIV/AIDS ( PWHAs ) who were enrolled in a r and omized clinical trial assessing the impact of a pain communication intervention .  Participants completed a series of self‐report measures including the Stressful Life Events Checklist ( SLE ) , the Posttraumatic Stress Disorder Checklist‐Civilian ( PCL‐C ) , the Mental Health Inventory ( MHI ) , and the Brief Pain Inventory ( BPI ) . On average , participants reported being exposed to 6.3 different types of trauma over the course of their lifetime , of which receiving an HIV diagnosis was rated as being among the most stressful . Over half ( 53.8 % ) merited a PTSD diagnosis according to the PCL‐C. Those with PTSD reported having significantly higher pain intensity and greater pain‐related interference in performance of daily activities ( i.e. , working , sleeping , walking ability and general activity ) , and affect ( i.e. , mood , relations with other people , enjoyment of life ) over time than those who did not meet the diagnostic criteria . Possible explanations for these findings are discussed along with implication s for clinical care Background : Initial posttraumatic stress disorder ( PTSD ) care is often delayed and many with PTSD go untreated . Acupuncture appears to be a safe , potentially nonstigmatizing treatment that reduces symptoms of anxiety , depression , and chronic pain , but little is known about its effect on PTSD . Methods : Fifty-five service members meeting research diagnostic criteria for PTSD were r and omized to  usual PTSD care ( UPC ) plus eight 60-minute sessions of acupuncture conducted twice weekly or to UPC alone . Outcomes were assessed at baseline and 4 , 8 , and 12 weeks postr and omization . The primary study outcomes were difference in PTSD symptom improvement on the PTSD Checklist ( PCL ) and the Clinician-administered PTSD Scale ( CAPS ) from baseline to 12-week follow-up between the 2 treatment groups . Secondary outcomes were depression , pain severity , and mental and physical health functioning . Mixed model regression and t test analyses were applied to the data . Results : Mean improvement in PTSD severity was significantly greater among those receiving acupuncture than in those receiving UPC ( PCL&Dgr;=19.8±13.3 vs. 9.7±12.9 , P<0.001 ; CAPS&Dgr;=35.0±20.26 vs. 10.9±20.8 , P<0.0001 ) . Acupuncture was also associated with significantly greater improvements in depression , pain , and physical and mental health functioning . Pre-post effect-sizes for these outcomes were large and robust . Conclusions : Acupuncture was effective for reducing PTSD symptoms . Limitations included small sample size and inability to parse specific treatment mechanisms . Larger multisite trials with longer follow-up , comparisons to st and ard PTSD treatments , and assessment s of treatment acceptability are needed . Acupuncture is a novel therapeutic option that may help to improve population reach of PTSD treatment Objective : To test the effectiveness of a stepped care intervention model targeting posttraumatic stress disorder ( PTSD ) symptoms after injury . Background : Few investigations have evaluated interventions for injured patients with PTSD and related impairments that can be feasibly implemented in trauma surgical setting s. Methods : The investigation was a pragmatic effectiveness trial in which 207 acutely injured hospitalized trauma survivors were screened for high PTSD symptom levels and then r and omized to a stepped combined care management , psychopharmacology , and cognitive behavioral psychotherapy intervention ( n = 104 ) or usual care control ( n = 103 ) conditions . The symptoms of PTSD and functional limitations were reassessed at 1 , 3 , 6 , 9 , and 12 months after the index injury admission . Results : Regression analyses demonstrated that over the course of the year after injury , intervention patients had significantly reduced PTSD symptoms when compared with controls [ group by time effect , CAPS ( Clinician-Administered PTSD Scale ) : F(2 , 185 ) = 5.50 , P < 0.01 ; PCL-C ( PTSD Checklist Civilian Version ) : F(4 , 185 ) = 5.45 , P < 0.001 ] . Clinical ly and statistically significant PTSD treatment effects were observed at the 6- , 9- , and 12-month postinjury assessment s. Over the course of the year after injury , intervention patients also demonstrated significant improvements in physical function [ MOS SF-36 PCS ( Medical Outcomes Study Short Form 36 Physical Component Summary ) main effect : F(1 , 172 ) = 9.87 , P < 0.01 ] . Conclusions : Stepped care interventions can reduce PTSD symptoms and improve functioning over the course of the year after surgical injury hospitalization . Orchestrated investigative and policy efforts could systematic ally introduce and evaluate screening and intervention procedures for PTSD at US trauma centers . ( Trial Registration : clinical trials.gov identifier : NCT00270959 Male veterans and their spouses ( N = 218 ) attending one of six-week-long retreats were assessed for  posttraumatic stress disorder ( PTSD ) symptoms pre- and postintervention . Participants were evaluated using the PTSD checklist ( PCL ) , on which , a score of > 49 indicates clinical symptom levels . The mean pretest score was 61.1 ( SD ± 12.5 ) for veterans and 42.6 ( SD ± 16.5 ) for spouses ; 83 % of veterans and 29 % of spouses met clinical criteria . The multimodal intervention used Emotional Freedom Techniques and other energy psychology ( EP ) methods to address PTSD symptoms and a variety of complementary and alternative medicine ( CAM ) modalities for stress reduction and re source building . Interventions were delivered in group format as well as individual counseling sessions . Data were analyzed for each retreat , as well as for the six retreats as a whole . Mean post-test PCL scores decreased to 41.8 ( SE ± 1.2 ; p < .001 ) for veterans , with 28 % still clinical . Spouses demonstrated substantial symptom reductions ( M = 28.7 , SE ± 1.0 ; p < .001 ) , with 4 % still clinical . A follow-up assessment ( n = 63 ) found PTSD symptom levels dropping even further for spouses ( p < .003 ) , whereas gains were maintained for veterans . The significant reduction in PTSD symptoms is consistent with other published reports of EP treatment , though counter to the usual long-term course of the condition . The results indicate that a multimodal CAM intervention incorporating EP may offer benefits to family members as well as veterans suffering from PTSD symptoms . Recommendations are made for further research to answer the questions posed by this study Objective : There is a growing body of literature supporting the use of creative arts therapies ; however , the efficacy of creative arts therapies in the treatment of  posttraumatic stress disorder ( PTSD )  has not been systematic ally evaluated . The aim of this systematic review was to examine the efficacy of creative arts therapy including music therapy , art therapy , dance/movement therapy , and drama therapy , in the treatment of PTSD . Method : Ten data bases were search ed for peer- review ed literature published from inception to December 2016 . Studies were included in the review if they used a r and omized controlled trial ( RCT ) , a pseudo RCT , or a controlled study design ; tested the efficacy of one of the creative arts therapies described above ; and reported changes to PTSD diagnosis or symptomatology . Results : From an initial yield of 1,918 records , 1,653 records were screened on title and abstract and 125 were screened at full-text . Seven studies met the inclusion criteria for review , with four studies investigating art therapy , two studies investigating music therapy , and a final study investigating drama therapy . Individual studies were initially rated on a st and ardized quality and bias checklist , and then GRADE was used to rate the overall evidence for each intervention . The evidence for music therapy , art therapy , and drama therapy  was ranked as low to very low , with no studies found for dance/movement therapy . Generally , the quality of the trials was very poor . Future directions for this field of research are to improve the scientific quality of the research trials in this area CONTEXT Abnormal cortisol levels are a key pathophysiological indicator of post-traumatic stress disorder ( PTSD ) . Endogenous normalization of cortisol concentration through exercise may be associated with PTSD symptom reduction . OBJECTIVE The aim of the study was to determine whether mindfulness-based stretching and deep breathing exercise ( MBX ) normalizes cortisol levels and reduces PTSD symptom severity among individuals with sub clinical features of PTSD . DESIGN AND SETTING A r and omized controlled trial was conducted at the University of New Mexico Health Sciences Center . PARTICIPANTS Twenty-nine nurses ( 28 female ) aged 45 - 66 years participated in the study . INTERVENTION Sixty-minute MBX sessions were conducted semiweekly for 8 weeks . MAIN OUTCOME MEASURES Serum cortisol was measured , and the PTSD Checklist-Civilian version ( PCL-C ) was performed at baseline and weeks 4 , 8 , and 16 . RESULTS Twenty-nine participants completed the study procedures , 22 ( 79 % ) with PTSD symptoms ( MBX , n = 11 ; control , n = 11 ) , and 7 ( 21 % ) without PTSD ( BASE group ) . Eight-week outcomes for the MBX group were superior to those for the control group ( mean difference for PCL-C scores , -13.6 ; 95 % confidence interval [ CI ] , -25.6 , -1.6 ; P = .01 ; mean difference for serum cortisol , 5.8 ; 95 % CI , 0.83 , 10.8 ; P = .01 ) . No significant differences were identified between groups in any other items . The changes in the MBX group were maintained at the 16-week follow-up ( P = .85 for PCL-C ; P = .21 for cortisol ) . Our data show that improved PTSD scores were associated with normalization of cortisol levels ( P < .05 ) . CONCLUSIONS The results suggest that MBX appears to reduce the prevalence of PTSD-like symptoms in individuals exhibiting sub clinical features of PTSD Diagnosis is a critical component of health care , and clinicians , policymakers , and patients routinely face a range of questions regarding diagnostic tests . They want to know whether testing improves outcome ; what test to use , purchase , or recommend in practice guidelines ; and how to interpret test results . Well- design ed  diagnostic test accuracy studies can help in making these decisions , provided that they transparently and fully report their participants , tests , methods , and results as facilitated , for example , by the STARD ( St and ards for Reporting of Diagnostic Accuracy ) statement ( 1 ) . That 25-item checklist was published in many journals and is now adopted by more than 200 scientific journals worldwide . As in other areas of science , systematic review s and meta- analysis of accuracy studies can be used to obtain more precise estimates when small studies addressing the same test and patients in the same setting are available . Review s can also be useful to establish whether and how scientific findings vary by particular subgroups , and may provide summary estimates with a stronger generalizability than estimates from a single study . Systematic review s may help identify the risk for bias that may be present in the original studies and can be used to address questions that were not directly considered in the primary studies , such as comparisons between tests . The Cochrane Collaboration is the largest international organization preparing , maintaining , and promoting systematic review s to help people make well-informed decisions about health care ( 2 ) . The Collaboration decided in 2003 to make preparations for including systematic review s of diagnostic test accuracy in their Cochrane Data base of Systematic Review s. To enable this , a working group ( Appendix ) . was formed to develop methodology , software , and a h and book The first diagnostic test accuracy review was published in the Cochrane Data base in October 2008 . In this paper , we review recent method ological developments concerning problem formulation , location of literature , quality assessment , and meta- analysis of diagnostic accuracy studies by using our experience from the work on the Cochrane H and book . The information presented here is based on the recent literature and up date s previously published guidelines by Irwig and colleagues ( 3 ) . Definition of the Objectives of the Review Diagnostic test accuracy refers to the ability of a test to distinguish between patients with disease ( or more generally , a specified target condition ) and those without . In a study of test accuracy , the results of the test under evaluation , the index test , are compared with those of the reference st and ard determined in the same patients . The reference st and ard is an agreed-on and accurate method for identifying patients who have the target condition . Test results are typically categorized as positive or negative for the target condition . By using such binary test outcomes , the accuracy is most often expressed as the test 's sensitivity ( the proportion of patients with positive results on the reference st and ard that are also positive on the index test ) and specificity ( the proportion of patients with negative results on the reference st and ard that are also negative on the index test ) . Other measures have been proposed and are in use ( 46 ) . It has long been recognized that test accuracy is not a fixed property of a test . It can vary between patient subgroups , with their spectrum of disease , with the clinical setting , or with the test interpreters and may depend on the results of previous testing . For this reason , inclusion of these elements in the study question is essential . In order to make a policy decision to promote use of a new index test , evidence is required that using the new test increases test accuracy over other testing options , including current practice , or that the new test has equivalent accuracy but offers other advantages ( 79 ) . As with the evaluation of interventions , systematic review s need to include comparative analyses between alternative testing strategies and should not focus solely on evaluating the performance of a test in isolation . In relation to the existing situation , 3 possible roles for a new test can be defined : replacement , triage , and add-on ( 7 ) . If a new test is to replace an existing test , then comparing the accuracy of both tests on the same population and with the same reference st and ard provides the most direct evidence . In triage , the new test is used before the existing test or testing pathway , and only patients with a particular result on the triage test continue the testing pathway . When a test is needed to rule out disease in patients who then need no further testing , a test that gives a minimal proportion of falsenegative results and thus a relatively high sensitivity should be used . Triage tests may be less accurate than existing ones , but they have other advantages , such as simplicity or low cost . A third possible role of a new test is add-on . The new test is then positioned after the existing testing pathway to identify false-positive or false-negative results after the existing pathway . The review should provide data to assess the incremental change in accuracy made by adding the new test . An example of a replacement question can be found in a systematic review of the diagnostic accuracy of urinary markers for primary bladder cancer ( 10 ) . Clinicians may use cytology to triage patients before they undergo invasive cystoscopy  , the reference st and ard for bladder cancer . Because cytology combines high specificity with low sensitivity ( 11 ) , the goal of the review was to identify a tumor marker with sufficient accuracy to either replace cytology or be used in addition to cytology . For a marker to replace cytology , it has to achieve equally high specificity with improved sensitivity . New markers that are sensitive but not specific may have roles as adjuncts to conventional testing . The review included studies in which the test under evaluation ( several different tumor markers and cytology ) was evaluated against cystoscopy or histopathology . Included studies compared 1 or more of the markers , cytology only , or a combination of markers and cytology . Although information on accuracy can help clinicians make decisions about tests , good diagnostic accuracy is a desirable but not sufficient condition for the effectiveness of a test ( 8) . To demonstrate that using a new test does more good than harm to patients tested , r and omized trials of test- and -treatment strategies and review s of such trials may be necessary . However , with the possible exception of screening , in most cases , such r and omized trials are not available and systematic review s of test accuracy may provide the most useful evidence available to guide clinical and health policy decision making and use as input for decision and cost-effectiveness analysis ( 12 ) . Identification and Selection of Studies Identifying test accuracy studies is more difficult than search ing for r and omized trials ( 13 ) . There is not a clear , unequivocal keyword or indexing term for an accuracy study in literature data bases comparable with the term r and omized , controlled trial . The Medical Subject Heading sensitivity and specificity may look suitable but is inconsistently applied in most electronic bibliographic data bases . Furthermore , data on diagnostic test accuracy may be hidden in studies that did not have test accuracy estimation as their primary objective . This complicates the efficient identification of diagnostic test accuracy studies in electronic data bases , such as MEDLINE . Until indexing systems properly code studies of test accuracy , search ing for them will remain challenging and may require additional manual search es , such as screening reference lists . In the development of a comprehensive search strategy , review authors can use search strings that refer to the test(s ) under evaluation , the target condition , and the patient description or a subset of these . For tests with a clear name that are used for a single purpose , search ing for publications in which those tests are mentioned may suffice . For other review s , adding the patient description may be necessary , although this is also often poorly indexed . A search strategy in MEDLINE should contain both Medical Subject Headings and free text words . A search strategy for articles about tests for bladder cancer , for example , should include as many synonyms for bladder cancer as possible in the search strategy , including neoplasm , carcinoma , transitional cell , and hematuria . Several method ological electronic search filters for diagnostic test accuracy studies have been developed , each attempting to restrict the search to articles that are most likely to be test accuracy studies ( 1316 ) . These filters rely on indexing terms for research methodology and text words used in reporting results , but they often miss relevant studies and are unlikely to decrease the number of articles one needs to screen . Therefore , they are not recommended for systematic review s ( 17 , 18 ) . The incremental value of search ing in language s other than English and in the gray literature has not yet been fully investigated . In systematic review s of intervention studies , publication bias is an important and well-studied form of bias in which the decision to report and publish studies is linked to their findings . For clinical trials , the magnitude and determinants of publication bias have been identified by tracing the publication history of cohorts of trials review ed by ethics committees and research boards ( 19 ) . A consistent observation has been that studies with significant results are more likely to be published than studies with nonsignificant findings ( 19 ) . Investigating publication bias for diagnostic tests is problematic , because many studies are done without ethical review or study registration ; therefore , identification of cohorts of studies from registration to final publication status This study evaluated the predictive validity of violence risk assessment s conducted using the HCR-20 , the Psychopathy Checklist : Screening Version ( PCL : SV ) , and by the Violence Screening Checklist ( VSC ) in a sample of 268 involuntarily hospitalized male and female psychiatric patients . Information pertaining to violence and crime was coded from medical charts and correctional records . The HCR-20/PCL : SV evidence d modest non-significant associations in postdictive assessment s of inpatient violence among men . Moderate to strong significant associations were found between the HCR-20/PCL : SV and inpatient violence among women . Pseudo- prospect i ve assessment s using the HCR-20 and PCL : SV result ed in moderate to large relationships with violence and crime in men and women following community discharge . It is concluded that the VSC is a promising tool for assessing acute inpatient violence risk with men . Findings offer preliminary validation of the predictive validity of the HCR-20 and PCL : SV with female civil psychiatric patients Importance Cognitive processing therapy ( CPT ) , an evidence -based treatment for posttraumatic stress disorder ( PTSD ) , has not been tested as an individual treatment among active-duty military .  Group CPT may be an efficient way to deliver treatment . Objective To determine the effects of CPT on PTSD and co-occurring symptoms and whether they differ when administered in an individual or a group format . Design , Setting , and Participants In this r and omized clinical trial , 268 active-duty servicemembers consented to assessment at an army medical center from March 8 , 2012 , to September 23 , 2014 , and were r and omized to group or individual CPT . Inclusion criteria were PTSD after military deployment and stable medication therapy . Exclusion criteria consisted of suicidal or homicidal intent or psychosis . Data collection was completed on June 15 , 2015 . Analysis was based on intention to treat . Interventions Participants received CPT ( the version excluding written accounts ) in 90-minute group sessions of 8 to 10 participants ( 15 cohorts total ; 133 participants ) or 60-minute individual sessions ( 135 participants ) twice weekly for 6 weeks . The 12 group and individual sessions were conducted concurrently . Main Outcomes and Measures Primary measures were scores on the Posttraumatic Symptom Scale – Interview Version ( PSS-I ) and the stressor-specific Posttraumatic Stress Disorder Checklist ( PCL-S ) ; secondary measures were scores on the Beck Depression Inventory – II ( BDI-II ) and the Beck Scale for Suicidal Ideation ( BSSI ) . Assessment s were completed by independent evaluators masked to treatment condition at baseline and 2 weeks and 6 months after treatment . Results Among the 268 participants ( 244 men [ 91.0 % ] ; 24 women [ 9.0 % ] ; mean [ SD ] age , 33.2 [ 7.4 ] years ) , improvement in PTSD severity at posttreatment was greater when CPT was administered individually compared with the group format ( mean [ SE ] difference on the PSS-I , −3.7 [ 1.4 ] ; Cohen d = 0.6 ; P = .006 ) . Significant improvements were maintained with the individual ( mean [ SE ] PSS-I , −7.8 [ 1.0 ] ; Cohen d = 1.3 ; mean [ SE ] PCL-S , −12.6 [ 1.4 ] ; Cohen d = 1.2 ) and group ( mean [ SE ] PSS-I , −4.0 [ 0.97 ] ; Cohen d = 0.7 ; mean [ SE ] PCL-S , −6.3 [ 1.4 ] ; Cohen d = 0.6 ) formats , with no differences in remission or severity of PTSD at the 6-month follow-up . Symptoms of depression and suicidal ideation did not differ significantly between formats . Conclusions and Relevance Individual treatment result ed in greater improvement in PTSD severity than group treatment .  Depression and suicidal ideation improved equally with both formats . However , even among those receiving individual CPT , approximately 50 % still had PTSD and clinical ly significant symptoms . In the military population , improving existing treatments such as CPT or developing new treatments is needed . Trial Registration clinical trials.gov identifier : This paper provides an up-to- date overview of the occurrence , diagnosis , risk factors , prognostic indicators and outcome of shoulder disorder ( SD ) , and of the validity and reproducibility of diagnostic classifications and diagnostic imaging techniques for SD . Furthermore , the available evidence on the effectiveness of non-steroidal anti-inflammatory drugs ( NSAIDs ) , corticosteroid injections and physiotherapy for SD is summarized on the basis of r and omized controlled trials with an acceptable quality of their methods . The annual incidence of SD is estimated at about 7 % , its 1-year period prevalence at about 51 % and its lifetime prevalence at about 10 % . While approximately 50 % of all patients with SD seek medical care , about 95 % are treated in primary health care . Of all new episodes of SD presenting to primary care , approximately 50 % seem to resolve within 6 months , while about 40 % seem to persist for up to 12 months . Several prognostic indicators for a favourable or a poor outcome of SD have been identified , but a comprehensive prognostic model is not available . While evidence for the prognostic validity of popular diagnostic classifications of SD is lacking , their reproducibility has been shown to be poor . The accuracy and clinical usefulness of diagnostic imaging techniques appear to be sufficiently verified for SD in secondary care , while their clinical usefulness in primary care and prognostic validity are not . NSAIDs and steroid injections for SD have been shown to be effective within 6 weeks , but their effect on long-term outcome remains unclear . There is very limited evidence for the effectiveness in SD of physiotherapy , including exercise therapy , ultrasound , electrotherapy , laser , mobilization and manipulation PURPOSE Scanning laser tomography with the Heidelberg retina tomograph ( HRT ; Heidelberg Engineering , Heidelberg , Germany ) has been proposed as a useful diagnostic test for glaucoma . This study was conducted to evaluate the quality of reporting of published studies using the HRT for diagnosing glaucoma . METHODS A vali date d Medline and h and search of English- language articles reporting on measures of diagnostic accuracy of the HRT for glaucoma was performed . Two review ers selected and appraised the papers independently . The St and ards for Reporting of Diagnostic Accuracy ( STARD ) checklist was used to evaluate the quality of each publication . RESULTS A total of 29 articles were included .  Interobserver rating agreement was observed in 83 % of items ( kappa=0.76 ) . The number of STARD items properly reported ranged from 5 to 18 . Less than a third of studies ( 7/29 ) explicitly reported more than half of the STARD items . Descriptions of key aspects of the methodology were frequently missing . For example , the design of the study ( prospect i ve or retrospective ) was reported in 6 of 29 studies , and details of participant sampling ( e.g. , consecutive or r and om selection ) were described in 5 of 29 publications . The commonest description of diagnostic accuracy was sensitivity and specificity ( 25/29 ) followed by area under the ROC curve ( 13/29 ) , with 9 of 29 publications reporting both . CONCLUSIONS The quality of reporting of diagnostic accuracy tests for glaucoma with HRT is suboptimal . The STARD initiative may be a useful tool for appraising the strengths and weaknesses of diagnostic accuracy studies Prior research indicates elevated but sub clinical posttraumatic stress disorder ( PTSD ) symptoms as a risk factor for a later diagnosis of PTSD . This study examined the progression of symptoms in 21 sub clinical veterans . Participants were r and omized into a treatment as usual ( TAU ) wait-list group and an experimental group , which received TAU plus six sessions of clinical emotional freedom techniques ( EFT ) . Symptoms were assessed using the PCL-M ( Posttraumatic Checklist-Military ) on which a score of 35 or higher indicates increased risk for PTSD . The mean pretreatment score of participants was 39 ± 8.7 , with no significant difference between groups . No change was found in the TAU group during the wait period . Afterward , the TAU group received an identical clinical EFT protocol . Posttreatment groups were combined for analysis . Scores declined to a mean of 25 ( -64 % , P < .0001 ) . Participants maintained their gains , with mean three-month and six-month follow-up PCL-M scores of 27 ( P < .0001 ) . Similar reductions were noted in the depth and breadth of psychological conditions such as anxiety . A Cohen 's d = 1.99 indicates a large treatment effect . Reductions in traumatic brain injury symptoms ( P = .045 ) and insomnia ( P = .004 ) were also noted . Symptom improvements were similar to those assessed in studies of PTSD-positive veterans  . EFT may thus be protective against an increase in symptoms and a later PTSD diagnosis . As a simple and quickly learned self-help method , EFT may be a clinical ly useful element of a resiliency program for veterans and active-duty warriors Background Hysterosalpingosonography has been suggested as a less invasive alternative to hysterosalpingography for detecting tubal occlusion among subfertile women . We aim to determine the diagnostic accuracy of hysterosalpingosonography and to compare it to hysterosalpingography . Methods / design We will conduct a systematic review of diagnostic test accuracy . We will search Medline , Embase , Cochrane Library , Web of Science and Biosis , as well as reference lists of included studies and previous related review articles . Diagnostic studies that compared hysterosalpingosonography ± hysterosalpingography to laparoscopy with chromotubation in women suffering from subfertility will be eligible . Two authors will independently screen for inclusion , data extraction , and quality assessment . Method ological quality will be assessed using the Quality Assessment of Diagnostic Accuracy Study 2 tool ( QUADAS-2 ) . We will use SAS 9.3 ( SAS Institute Inc. , Cary , NC , USA , 2011 ) to program bivariate r and om-effects models , estimate pooled sensitivity and specificity with 95 % confidence intervals and to generate summary receiver operating characteristics curves . We will perform sensitivity analyses to examine the effect of differences in techniques used for hysterosalpingosonography and in method ological quality of studies . Discussion This systematic review will help to determine if hysterosalpingosonography is an adequate alternative screening test for diagnosing tubal occlusion . Accuracy of specific sono-HSG techniques may also be identified . Systematic review registration This review has been registered at PROSPERO . The registration number is OBJECTIVE This r and omized controlled trial examined the effectiveness of a nurse assisted online cognitive-behavioral self-management intervention for war-related posttraumatic stress disorder ( PTSD ) , compared to optimized usual primary care PTSD Treatment ( OUC ) to reduce PTSD symptoms . METHOD Participants were 80 veterans of recent military conflicts with PTSD as assessed by the PTSD Checklist ( PCL ) seeking primary care treatment at one of three Veterans Affairs ( VA ) and four Army clinics .  DESTRESS-PC consisted of logins to a secure website three times per week for 6 weeks with monitoring by a study nurse . All participants received nurse care management in the form of phone check-ins every two weeks and feedback to their primary care providers . Blinded raters assessed outcomes 6 , 12 , and 18 weeks post-r and omization . RESULTS DESTRESS-PC was associated with a significantly greater decrease in PTSD symptoms compared to OUC ( F(3 , 186)=3.72 , p=.012 ) . The effect was largest at the 12-week assessment ( ∆PCL=12.6±16.6 versus 5.7±12.5 , p<0.05 ) with the treatment effect disappearing by the 18-week follow-up . Notably , there was a dose effect ; number of logins correlated significantly with PTSD outcomes , with more logins associated with greater PTSD symptom improvement . None of the secondary outcomes ( depression , anxiety , somatic symptoms , and functional status ) showed statistically significant improvement ; however , the treatment effect on depression approached significance ( F(3 , 186)=2.17 , p=.093 ) . CONCLUSIONS DESTRESS-PC shows promise as a means of delivering effective , early PTSD treatment in primary care . Larger trials are needed OBJECTIVE The authors assessed the efficacy of trauma memory reactivation performed under the influence of propranolol , a noradrenergic beta-receptor blocker , as a putative reconsolidation blocker , in reducing symptoms of  posttraumatic stress disorder ( PTSD ) . METHOD This was a 6-week , double-blind , placebo-controlled , r and omized clinical trial in 60 adults diagnosed with long-st and ing PTSD .  Propranolol or placebo was administered 90 minutes before a brief memory reactivation session , once a week for 6 consecutive weeks . The hypothesis predicted a significant treatment effect of trauma reactivation with propranolol compared with trauma reactivation with placebo in reducing PTSD symptoms on both the Clinician-Administered PTSD Scale ( CAPS ) and the patient-rated PTSD Checklist-Specific ( PCL-S ) in an intention-to-treat analysis . RESULTS The estimated group difference in posttreatment CAPS score , adjusted for pretreatment values ( analysis of covariance ) , was a statistically significant 11.50 . The within-group pre- to posttreatment effect sizes ( Cohen 's d ) were 1.76 for propranolol and 1.25 for placebo . For the PCL-S , the mixed linear model 's estimated time-by-group interaction yielded an average decrease of 2.43 points per week , for a total significant difference of 14.58 points above that of placebo . The pre- to posttreatment effect sizes were 2.74 for propranolol and 0.55 for placebo . Per protocol analyses for both outcomes yielded similar significant results . CONCLUSIONS Pre-reactivation propranolol , a treatment protocol suggested by reconsolidation theory , appears to be a novel and efficacious treatment for PTSD . Replication studies using a long-term follow-up in various trauma population s are required Objective : To consider the extent to which the presence of psychopathy , as indicated by the psychopathy checklist : screening version ( PCL : SV ) , can predict intramural behaviour in offenders with mental disorders serving compulsory treatment at a German forensic psychiatric hospital . Method : The PCL : SV was used with 48 offenders detained at a forensic psychiatric hospital in Germany . In a prospect i ve design , objective and subjective measures of behaviour were compared for those identified as high and low scorers on the PCL : SV . Data were obtained from hospital records of disciplinary incidents ( objective ) and from interviews with case managers and therapists ( subjective ) , according to predefined criteria and in st and ardized forms . Results : The hospital records of the high scorers indicated they had been involved in significantly more disciplinary incidents than low scorers . Their behaviour was also rated significantly more negative by therapists than the low scorers . Conclusion : Numeorus studies found the  psychopathy checklist ( PCL ) score to be a reliable predictor of recidivism in offenders after release . The present study has demonstrated that the  PCL score has also predictive validity for intramural behaviour problems in individuals serving compulsory treatment at a forensic psychiatric hospital . As a result , we recommend the routine use of the PCL with offenders starting a period of compulsory detention to identify those at increased risk for problem behaviour An open trial design was used to examine the implementation and effectiveness of a cognitive-behavioral intervention ( Seeking Safety ) for comorbid post-traumatic stress disorder ( PTSD ) and substance use disorder ( SUD ) for incarcerated women with Axis I mental disorders who self-referred for specialty trauma treatment . The study sample was female inmates aged 18 and old who were primarily minority , had experienced childhood-based trauma , committed violent crimes , had a serious mental illness , and resided in maximum , medium , and minimum compounds of a women 's prison . A total of 74 women completed the group intervention , with the average attending 23 of the 28 sessions ( 82 % ) . Implementation feasibility was demonstrated by the ability to recruit , screen , assign , and retain participation . Effectiveness was supported by changes pre-post intervention on the PTSD Checklist ( ES=0.56 ) and Global Severity Index ( ES=0.47 ) . Of the 19 completers with PCL scores of 50 or higher pre-intervention , 16 ( 84 % ) had scores below 50 , the " cut score " consistent with or supportive of a PTSD diagnosis . Three-quarters or more of participants reported that Seeking Safety was helpful in each of the following areas : overall , for traumatic stress symptoms , for substance use , to focus on safety , and to learn safe coping skills . Future directions include the need for larger scale r and omized controlled trials in medium or maximum security prisons and fidelity evaluations of non- research dissemination efforts Objective : This study examined the predictive validity of the German translation of the Psychopathy Checklist-Screening Version ( PCL-SV ) for negative events during the course of the prison sentence of German prisoners . Method : Using the PCL-SV , we investigated 145 offenders in a German prison at the start of their sentences . We then compared the extreme groups identified by the PCL-SV — the high and low scorers — using a prospect i ve design with respect to negative events and factors during the course of the sentences . This involved the st and ardized collection of data on both objective records of disciplinary incidents and subjective impressions from prison staff on the basis of operationalized criteria . Results : The high scorers were involved in significantly more disciplinary incidents and were also rated significantly less favourably by prison staff than the low scorers . Conclusion : Until now , the PCL has only been shown to predict recidivism following release from prison . The results of our study show that the PCL also has predictive validity for problems during the course of the sentence . It is therefore recommended that the PCL be used routinely at the start of the prison sentence to estimate the likelihood of subsequent difficulties Background The physical wellbeing of people with mental health conditions can often be overlooked in order to treat the primary mental health condition as a priority . Exercise however , can potentially improve both the primary psychiatric condition as well as physical measures that indicate risk of other conditions such as diabetes mellitus and cardiovascular disease . Evidence supports the role of exercise as an important component of treatment for depression and anxiety , yet no r and omised controlled trials ( RCT 's ) have been conducted to evaluate the use of exercise in the treatment of people with post traumatic stress disorder (PTSD).This RCT will investigate the effects of structured , progressive exercise on PTSD symptoms , functional ability , body composition , physical activity levels , sleep patterns and medication usage . Methods and design Eighty participants with a Diagnostic and Statistical Manual of Mental Disorders ( DSM-IV ) diagnosis of PTSD will be recruited . Participants will have no contraindications to exercise and will be cognitively able to provide consent to participate in the study .The primary outcome measures will be PTSD symptoms , measured through the PTSD Checklist Civilian ( PCL-C ) scale . Secondary outcome measures will assess depression and anxiety , mobility and strength , body composition , physical activity levels , sleep patterns and medication usage . All outcomes will be assessed by a health or exercise professional masked to group allocation at baseline and 12 weeks after r and omisation . The intervention will be a 12 week individualised program , primarily involving resistance exercises with the use of exercise b and s. A walking component will also be incorporated . Participants will complete one supervised session per week , and will be asked to perform at least two other non-supervised exercise sessions per week . Both intervention and control groups will receive all usual non-exercise interventions including psychotherapy , pharmaceutical interventions and group therapy . Discussion This study will determine the effect of an individualised and progressive exercise intervention on PTSD symptoms , depression and anxiety , mobility and strength , body composition , physical activity levels , sleep patterns and medication usage among people with a DSM-IV diagnosis of PTSD.Trial Registration
Findings indicated that although studies generally met st and ards in several quality areas , there is still room for improvement .
Areas for improvement include establishing representativeness , adequately describing clinical and demographic characteristics of the sample , and presenting better descriptions of important aspects of test and reference st and ard execution .
In addition , study quality has not appreciably improved since the publication of the STARD Statement in 2003 .
Despite the popularity of the PTSD Checklist ( PCL ) as a clinical screening test , there has been no comprehensive quality review of studies evaluating its diagnostic accuracy .