bluuebunny/crossref_metadata_2025 huggingface dataset:
Does Interview Date Affect Match List Position in the Emergency Medicine National Residency Matching Program Match?
Authors: Martin‐Lee LeeAnne , Park HaeWon , Overton David T. ,   The Emergency Medicine Residency Interview Date Study Group
Published: August 2010

Abstract. Objective: Some residency applicants believe that the date on which they interview with a residency program influences how the program ranks them in the National Residency Matching Program (NRMP). Therefore, the authors studied whether interview date affects match list position in the emergency medicine (EM) residency match. Methods: Forty‐four Accreditation Council for Graduate Medical Education (ACGME)‐accredited EM residency programs participated in this multicenter study. The interview date and match list position were collected for each interviewee for the 1997‐98 season. Programs were also asked about factors that might potentially bias interview date assignment. Statistical analyses were performed both with and without these programs included. Interview dates and match list positions were standardized into percentile date and percentile rank for each program and were compared using linear regression analysis. Scatterplots graphed interview date vs match list position. Two‐sample t‐tests compared interview dates for ranked and nonranked interviewees. Results: Data were collected for 3,800 individual interviews; 14% of these resulted in unranked applicants. Twenty‐three programs, representing 1,997 interviews, reported potential bias in their interview date assignment. Regression analysis revealed an R2 of 0.018268 (correlation coefficient = 0.1352, 95% CI = 0.0992 to 0.1617) for all programs, R2 of 0.010626 (correlation coefficient = 0.1031, 95% CI = 0.0571 to 0.1485) for programs without reported potential bias, and R2 of 0.02444 (correlation coefficient = 0.1563, 95% CI = 0.10887 to 0.20309) for programs with reported bias. Scatterplots revealed no linear correlation. Two‐sample t‐tests for all programs, and programs with and without reported bias showed no significant difference in average interview date for ranked and unranked interviewees (both with p > 0.2). Conclusion: In this study, interview date for EM residency positions in the 1997‐98 season did not affect match list position among ranked applicants. Moreover, interview date had nno effect on the decision to leave candidates unranked.
Preventive Care in the Emergency Department, Part I: Clinical Preventive Services—Are They Relevant to Emergency Medicine?*
Authors: Rhodes Karin V. , Gordon James A. , Lowe Robert A. ,   The Society for Academic Emergency Medicine Public Health and Education Task Force Preventive Services Work Group
Published: August 2010

Abstract. In 1998 the Society for Academic Emergency Medicine's (SAEM's) Board of Directors asked the SAEM Public Health and Education Task Force to develop recommendations for prevention, screening, and counseling activities to be conducted in emergency departments (EDs). The Task Force's work was divided into two phases: 1) a discussion of the rationale for preventive services in the ED, along with generation of a preliminary list of prevention activities that could be studied for ED implementation; and 2) a formal evidence‐based review of topics chosen from the preliminary list, along with recommendations for ED implementation and further study. This paper represents Phase I of the project. Phase II, the formal evidence‐based review and recommendations, is published separately in this issue.
Pediatric Emergency Medicine Education in Emergency Medicine Training Programs
Authors: Tamariz Vincent P , Fuchs Susan , Baren Jill M , Pollack Emily S , Kim Joseph , Seidel James S ,   For the Same Pediatric Education Training Task Force
Published: August 2010

Abstract. Background: The educational goal of emergency medicine (EM) programs has been to prepare its graduates to provide care for a diverse range of patients and presentations, including pediatric patients. Objective: To evaluate the methods used to teach pediatric emergency medicine (PEM) to EM residents. Methods: A written questionnaire was distributed to 118 EM programs. Demographic data were requested concerning the type of residency program, number of residents, required pediatric rotations, elective pediatric rotations, type of hospital and settings in which pediatric patients are seen, and procedures performed. Information was also requested on the educational methods used, proctoring EM received, and any formal curriculum used. Results: Ninety‐four percent (111/118) of the programs responded, with 80% of surveys completed by the residency director. Proctoring was primarily performed by PEM attendings and general EM attendings. Formal means of PEM education most often included the EM core curriculum (94%), journal club (95%), EM grand rounds (94%), and EM morbidity and mortality (M&M) conference (91%). Rotations and electives most often included the pediatric intensive care unit (PICU) and the emergency department (ED) (general and pediatric). Conclusions: Emergency medicine residents are exposed to PEM primarily by rotating through a general ED, the PED, and the PICU, being proctored by PEM and EM attendings and attending EM lectures and EM M&M conferences. Areas that may merit further attention for pediatric emergency training include experience in areas of neonatal resuscitation, pediatric M&M, and specific pediatric electives. This survey highlights the need to describe current educational strategies as a first step to assess perceived effectiveness.
Emergency Severity Index Triage Category Is Associated with Six‐month Survival
Authors: Wuerz Richard
Published: August 2010

Abstract. Objective: The Emergency Severity Index (ESI) is a new five‐level triage instrument. The objective of this study was to determine whether there is an association between ESI triage status and short‐term survival. Methods: This was a survival analysis for a population‐based, stratified random sample of patients over the age of 14 years who visited an urban, university‐affiliated hospital emergency department (ED). Measures included ESI triage category (1 through 5), vital status obtained from the Social Security Administration, date of death (if applicable), and survival time in days. Data were analyzed with Kaplan‐Meier survival analysis. Results: Eighty‐seven percent (202/232) of a random sample of patients appeared in the Social Security vital status registry. During the 252‐day follow‐up period, 19 patients (9%) died, 161 (80%) lived, and 22 (11%) had an unknown vital status. The ESI triage level was strongly associated with vital status at six months (Kaplan‐Meier chi‐square 25.9, p < 0.0001). No patient in triage categories 4 and 5 died (lower limits of the 95% confidence interval for survival, 92% and 93%, respectively); whereas survival in triage category 1 was 68%, and in categories 2 and 3 it was 86% and 83%, respectively. Most of the deaths occurred within 60 days after the index ED visit. Sensitivity analyses biased against the instrument continued to demonstrate the association between triage status and survival. Conclusions: The ESI triage status is associated with six‐month survival. Patients with the highest three triage groups experienced decreased survival during the follow‐up period, whereas all patients in the two lowest triage strata survived at least six months.
AAEM, CORD, and SAEM Reach a Landmark Position: Consensus Recommendations to the Federation of State Medical Boards (FSMB) for Revisions to the FSMB May 1998 Policy Statement on Physician Licensure3
Authors: Kazzi A. Antoine ,   The SAEM—CORD—AAEM Writing Group
Published: August 2010

Abstract. As a result of months of meetings and deliberations coordinated with the Medical Board of California and chaperoned by the California Chapter of the American Academy of Emergency Medicine (CAL/AAEM), the Society for Academic Medicine (SAEM), the Council of Emergency Medicine Residency Directors (CORD), and the American Academy of Emergency Medicine (AAEM) recently reached a landmark agreement on recommendations to the Federation of State Medical Boards (FSMB) pertaining to controversial May 1998 FSMB recommendations regarding physician licensure. Endorsed unanimously by the boards of all three emergency medicine (EM) organizations, the recommendations of this consensus have been forwarded to the FSMB and await its official response. The recommendations will also be forwarded to remaining EM organizations and to the medical community for comment and to enlist their support.
Does the Sedative Agent Facilitate Emergency Rapid Sequence Intubation?
Authors: Sivilotti Marco L. A. , Filbin Michael R. , Murray Heather E. , Slasor Peter , Walls Ron M. ,   On behalf of the NEAR Investigators
Published: August 2010

Objectives:To ascertain whether the sedative agent administered during neuromuscular‐blocking agent‐facilitated intubation (rapid sequence intubation [RSI]) influences the number of attempts and overall success at RSI.Methods:Records were drawn from an ongoing, prospective multicenter registry of emergency department intubations. Conditional logistic regression stratified by institution was used to identify factors associated with multiple intubation attempts and unsuccessful RSI.Results:Of 3,407 intubations over 33 months in 22 institutions, 2,380 involved RSI. After correcting for the specialty and experience of the intubator and for the presence of airway aberrancy, the sedative agent was significantly associated with the number of attempts at intubation (p = 0.002). Specifically, the use of etomidate (adjusted odds ratio [OR] 0.35 [95% CI = 0.17 to 0.72]), ketamine (OR 0.27 [95% CI = 0.11 to 0.65]), a benzodiazepine (OR 0.47 [95% CI = 0.23 to 0.95]), or no sedative agent (OR 0.51 [95% CI = 0.23 to 1.13]) prior to neuromuscular blockade was associated with a lower likelihood of successful intubation on the first attempt, as compared with thiopental, methohexital, or propofol. The adjusted odds ratios for the likelihood of overall success had similar point estimates, but did not reach statistical significance due to lack of power (p = 0.2, with 36 unsuccessful intubations). Among patients receiving etomidate, intubation was more likely to be successful on the first attempt with increasing doses of either etomidate or succinylcholine.Conclusions:Thiopental, methohexital, and propofol appear to facilitate RSI in emergency department patients, independent of patient characteristics or intubator training. A deeper plane of anesthesia may improve intubating conditions in emergency patients undergoing RSI by complementing incomplete muscle paralysis.
Attending and Resident Satisfaction with Feedback in the Emergency Department
Authors: Yarris Lalena M , Linden Judith A. , Gene Hern H. , Lefebvre Cedric , Nestler David M. , Fu Rongwei , Choo Esther , LaMantia Joseph , Brunett Patrick ,   on behalf of the Emergency Medicine Education Research Group (EMERGe)
Published: August 2010

Objectives:  Effective feedback is critical to medical education. Little is known about emergency medicine (EM) attending and resident physician perceptions of feedback. The focus of this study was to examine perceptions of the educational feedback that attending physicians give to residents in the clinical environment of the emergency department (ED). The authors compared attending and resident satisfaction with real‐time feedback and hypothesized that the two groups would report different overall satisfaction with the feedback they currently give and receive in the ED.

Methods:  This observational study surveyed attending and resident physicians at 17 EM residency programs through web‐based surveys. The primary outcome was overall satisfaction with feedback in the ED, ranked on a 10‐point scale. Additional survey items addressed specific aspects of feedback. Responses were compared using a linear generalized estimating equation (GEE) model for overall satisfaction, a logistic GEE model for dichotomized responses, and an ordinal logistic GEE model for ordinal responses.

Results:  Three hundred seventy‐three of 525 (71%) attending physicians and 356 of 596 (60%) residents completed the survey. Attending physicians were more satisfied with overall feedback (mean score 5.97 vs. 5.29, p < 0.001) and with timeliness of feedback (odds ratio [OR] = 1.56, 95% confidence interval [CI] = 1.23 to 2.00; p < 0.001) than residents. Attending physicians were also more likely to rate the quality of feedback as very good or excellent for positive feedback, constructive feedback, feedback on procedures, documentation, management of ED flow, and evidence‐based decision‐making. Attending physicians reported time constraints as the top obstacle to giving feedback and were more likely than residents to report that feedback is usually attending initiated (OR = 7.09, 95% CI = 3.53 to 14.31; p < 0.001).

Conclusions:  Attending physician satisfaction with the quality, timeliness, and frequency of feedback given is higher than resident physician satisfaction with feedback received. Attending and resident physicians have differing perceptions of who initiates feedback and how long it takes to provide effective feedback. Knowledge of these differences in perceptions about feedback may be used to direct future educational efforts to improve feedback in the ED.
Real‐Time Inter‐Rater Reliability of the Council of Emergency Medicine Residency Directors Standardized Direct Observation Assessment Tool
Authors: LaMantia Joseph , Kane Bryan , Yarris Lalena , Tadros Anthony , Ward Mary Frances , Lesser Martin , Shayne Philip ,   The SDOT Study Group II
Published: August 2010

Objectives:  Developed by the Council of Emergency Medicine Residency Directors (CORD), the standardized direct observation assessment tool (SDOT) is an evaluation instrument used to assess residents’ clinical skills in the emergency department (ED). In a previous study examining the inter‐rater agreement of the tool, faculty scored simulated resident–patient encounters. The objective of the present study was to evaluate the inter‐rater agreement of the SDOT in real‐time evaluations of residents in the ED.

Methods:  This was a multi‐center, prospective, observational study in which faculty raters were paired to simultaneously observe and independently evaluate a resident’s clinical performance using the SDOT. Data collected from eight emergency medicine (EM) residency programs produced 99 unique resident–patient encounters and reported on 26 individual behaviors related to specific core competencies, global evaluation scores for each core competency, and an overall clinical competency score. Inter‐rater agreement was assessed using percentage agreement analyses with three constructs: exact agreement, liberal agreement, and binary (pass/fail) agreement.

Results:  Inter‐rater agreement between faculty raters varied according to category of measure used. Exact agreement ranged from poor to good, depending on the measure: the overall competency score (good), the competency score for each of the six core competencies (poor to good), and the individual item scores (fair to very good). Liberal agreement and binary agreement were excellent for the overall competency score and the competency score for each of the six core competencies and very good to excellent for the individual item scores.

Conclusions:  The SDOT demonstrated excellent inter‐rater agreement when analyzed with liberal agreement and when dichotomized as a pass/fail measure and fair to good agreement for most measures with exact agreement. The SDOT can be useful and reliable when evaluating residents’ clinical skills in the ED, particularly as it relates to marginal performance.
Neuroprotection in acute ischemic stroke – current status
Authors: Auriel E. , Bornstein N.M.
Published: August 2010

With the growing understanding of the mechanism of cell death in ischemia, new approaches for treatment such as neuroprotection have emerged. The basic aim of this strategy is to interfere with the events of the ischemic cascade, blocking the pathological processes and preventing the death of nerve cells in the ischemic penumebra. This concept involves inhibition of the pathological molecular events which eventually leads to the influx of calcium, activation of free radicals and neuronal death. Despite encouraging data from experimental animal models, all clinical trials of neuroprotective therapies have to date been unsuccessful. This article reviews some of the reasons for the failure of neuroprotection in the clinical trials so far. Despite all the negative reports, we believe it would be wrong to give up at this point, since there is still reasonable hope of finding an effective neuroprotection for stroke.
Vascular biology: the role of sphingosine 1‐phosphate in both the resting state and inflammation
Authors: Swan David J. , Kirby John A. , Ali Simi
Published: August 2010

Introduction

Biochemistry of sphingosine 1‐phosphate

S1P receptor biology

The vascular gradient of sphingosine 1‐phosphate

Role of S1P on vascular endothelium

Crosstalk between S1PR and other receptors

Therapies targeting the S1P signalling axis

Summary and future directions

The vascular and immune systems of mammals are closely intertwined: the individual components of the immune system must move between various body compartments to perform their function effectively. Sphingosine 1‐phosphate (S1P), a bioactive lipid mediator, exerts effects on the two organ systems and influences the interaction between them. In the resting state, the vascular S1P gradient contributes to control of lymphocyte recirculation through the blood, lymphoid tissue and lymphatic vasculature. The high level of S1P in blood helps maintain endothelial barrier integrity. During the inflammatory process, both the level of S1P in different immune compartments and S1P receptor expression on lymphocytes and endothelial cells are modified, resulting in functionally important changes in endothelial cell and lymphocyte behaviour. These include transient arrest of lymphocytes in secondary lymphoid tissue, crucial for generation of adaptive immunity, and subsequent promotion of lymphocyte recruitment to sites of inflammation. This review begins with an outline of the basic biochemistry of S1P. S1P receptor signalling is then discussed, followed by an exploration of the roles of S1P in the vascular and immune systems, with particular focus on the interface between them. The latter part concerns crosstalk between S1P and other signalling pathways, and concludes with a look at therapies targeting the S1P‐S1P receptor axis.
Arterial calcifications
Authors: Rennenberg Roger. J. M. W. , Schurgers Leon J. , Kroon Abraham A. , Stehouwer Coen D. A.
Published: August 2010

Introduction

Arterial calcification in specific patient populations at high risk for cardiovascular disease

Summary

Arterial calcifications as found with various imaging techniques, like plain X‐ray, computed tomography or ultrasound are associated with increased cardiovascular risk. The prevalence of arterial calcification increases with age and is stimulated by several common cardiovascular risk factors. In this review, the clinical importance of arterial calcification and the currently known proteins involved are discussed. Arterial calcification is the result of a complex interplay between stimulating (bone morphogenetic protein type 2 [BMP‐2], RANKL) and inhibitory (matrix Gla protein, BMP‐7, osteoprotegerin, fetuin‐A, osteopontin) proteins. Vascular calcification is especially prevalent and related to adverse outcome in patients with renal insufficiency and diabetes mellitus. We address the special circumstances and mechanisms in these patient groups. Treatment and prevention of arterial calcification is possible by the use of specific drugs. However, it remains to be proven that reduction of vascular calcification in itself leads to a reduced cardiovascular risk.
Red wine antioxidant resveratrol‐modified cardiac stem cells regenerate infarcted myocardium
Authors: Gurusamy Narasimman , Ray Diptarka , Lekli Istvan , Das Dipak K.
Published: August 2010

Introduction

Stem cell therapy

Regeneration of myocardium 28 days after myocardial infarction

Concluding remarks

To study the efficiency of maintaining the reduced tissue environment via pre‐treatment with natural antioxidant resveratrol in stem cell therapy, we pre‐treated male Sprague‐Dawley rats with resveratrol (2.5 mg/kg/day gavaged for 2 weeks). After occlusion of the left anterior descending coronary artery (LAD), adult cardiac stem cells stably expressing EGFP were injected into the border zone of the myocardium. One week after the LAD occlusion, the cardiac reduced environment was confirmed in resveratrol‐treated rat hearts by the enhanced expression of nuclear factor‐E2‐related factor‐2 (Nrf2) and redox effector factor‐1 (Ref‐1). In concert, cardiac functional parameters (left ventricular ejection fraction and fractional shortening) were significantly improved. The improvement of cardiac function was accompanied by the enhanced stem cell survival and proliferation as demonstrated by the expression of cell proliferation marker Ki67 and differentiation of stem cells towards the regeneration of the myocardium as demonstrated by the enhanced expression of EGFP 28 days after LAD occlusion in the resveratrol‐treated hearts. Our results demonstrate that resveratrol maintained a reduced tissue environment by overexpressing Nrf2 and Ref‐1 in rats resulting in an enhancement of the cardiac regeneration of the adult cardiac stem cells as demonstrated by increased cell survival and differentiation leading to cardiac function.
The role of epicardial and perivascular adipose tissue in the pathophysiology of cardiovascular disease
Authors: Ouwens D. Margriet , Sell Henrike , Greulich Sabrina , Eckel Juergen
Published: August 2010

Introduction

Fat depots around the heart and vasculature

Physiological function of epicardial adipose tissue

Visualization of epicardial adipose tissue

Epicardial fat thickness as diagnostic marker

Visualization of perivascular adipose tissue

Expression and secretion of fatty acids and adipokines from epicardial and perivascular fat depots

Cross‐talk between secretory products from EAT and the myocardium

Cross‐talk between secretory products from PVAT and the vasculature

Perspectives and conclusions

Obesity, insulin resistance and the metabolic syndrome, are characterized by expansion and inflammation of adipose tissue, including the depots surrounding the heart and the blood vessels. Epicardial adipose tissue (EAT) is a visceral thoracic fat depot located along the large coronary arteries and on the surface of the ventricles and the apex of the heart, whereas perivascular adipose tissue (PVAT) surrounds the arteries. Both fat depots are not separated by a fascia from the underlying tissue. Therefore, factors secreted from epicardial and PVAT, like free fatty acids and adipokines, can directly affect the function of the heart and blood vessels. In this review, we describe the alterations found in EAT and PVAT in pathological states like obesity, type 2 diabetes, the metabolic syndrome and coronary artery disease. Furthermore, we discuss how changes in adipokine expression and secretion associated with these pathological states could contribute to the pathogenesis of cardiac contractile and vascular dysfunction.
Clopenthixol and flupenthixol depot preparations in outpatient schizophrenics: II. FACTOR ANALYSIS OF THE CPRS SUB‐SCALE FOR SCHIZOPHRENIA
Authors: Dencker S. J. , Frankenberg K. , Hansen V. , Malm U.
Published: August 2010

Eleven factors were obtained by factor analysing the CPRS results from a longitudinal treatment process study in chronic schizophrenics during maintenance phase. Such factors may give more reliable information than the single item. Two factors ‐ “anxiety‐depression‐asthenia” and “psychotic” (psychotic schizophrenic symptoms and signs) ‐ nonpsychotic rating of anxiety and depressive symptoms as well as definite psychotic‐schizophrenic symptoms, respectively ‐ demonstrated special value for the clinical work, i.e. being relevant instrument for monitoring a treatment process.
Clopenthixol and flupenthixol depot preparations in outpatient schizophrenics: III. SERUM LEVELS
Authors: Jørgensen A. , Overø K. Fredricson
Published: August 2010

Serum concentrations of clopenthixol and flupenthixol have been determined during a four weeks dosage interval in patients trelated with intramuscular injections of clopenthixol decanoate or flupenthixol palmitate in Viscoleo®. Maximal drug levels were attained by the end of the first week after injection of either preparation. A period of exponential decline was then recorded. The half‐lives were estimated to 19 days for clopenthixol and 17 days for flupenthixol. These half‐lives most likely refer to the rate of release from the oil depot and not to elimination of drug. The mean ratio between maximal and minimal drug levels was 2.5 for clopenthixol and 3.7 for flupenthixol. Systemic clearance was estimated to about 0.7/min and 0.5/min, respectively.

Significant correlation was found between the administered doses and recorded serum levels, between doses and estimated areas under the serum concentration curves, and also between areas and drug levels. The data indicate more limited individual variability than that seen with other psychotropic drugs, given orally.

The study clearly demonstrates, that significant serum levels of active drug is maintained throughout the dosage interval by intramuscular injection of clopenthixol decanoate or flupenthixol palmitate in VisColed® every fourth week.
Clopenthixol and flupenthixol depot preparations in outpatient schizophrenics: IV. SERUM LEVELS AND CLINICAL OUTCOME
Authors: Dencker S. J. , Malm U. , Jørgensen A. , Overø K. Fredricson
Published: August 2010

Two pharmacokinetic parameters viz. the minimum serum concentration in the dosage interval and the area under the serum concentration curve have been correlated to 14 parameters for clinical outcome, viz. total points and factor points from the three rating scales, BPRS, CPRS, and side effects scale, in a double blind clinical trial of clopenthixol and flupenthixol depot preparations in outpatient schizophrenics.

No statistically significant correlations were observed. It is of some interest, however, that the results suggest that the treatment of individual patients with neuroleptics may be adjusted by means of repeated ratings, residual percentage, changes in psychopathology, and determinations of serum concentrations.

Our results do not indicate any optimal concentration range for these depot neuroleptics in the maintenance phase of schizophrenia. The so‐called therapeutic window as to neuroleptics obviously varies with regard to the phase of the disease as well as the patients' social situation.
Biological psychiary and ethics
Authors: Lunn Villars
Published: August 2010

The crucial concept of biological psychiatry ‐ comprising psychochemistry, psycho‐physiology and psycho‐pharmacology and based on a positivistic scientific view ‐ is explanation through the demonstration of causal material connections.

Conversely the central concept of the psycho‐dynamic schools, based on a hermeneutic‐finalistic ideology, is understanding, pertinent to the meaning of psychical symptoms.

The two models are not mutually exclusive but represent complementary concepts whose mutual scientific value can only be measured through their mutual utility as basis for etiological research and for the choice of treatment.

Since the age of Enlightment in the 18th century the concept of reason in the shape of an unambigous scientific attitude extensively has rendered the ethics redundant. However, our time is characterized by a reaction against this rationalistic concept about science as a substitute for morality. First of all biological psychiatry, based on the methods of the natural sciences, has been the subject of denunciation and underevaluation with deep emotional undertones.

The anti‐psychiatric movement, the “critical psychiatry”, talks about the psychotic patient as the scapegoat, carrying the burden of the relatives conflicts on his shoulders ‐ thus reintroducing the concept of guilt in the debate.

The author claims that the relief for this guilt feeling will be found in the paradigme who regards the endogenous psychoses as biologically determined diseases and not simply as reactions to psychological and social strain.

The moral‐philosophical counterpart to the antagonism: positivism versus hermeneutics is found in the dualism: determinism versus indeterminism.

Realizing the immanent incomprehensibility of the concept of volition the author argues ‐ again from an utilitaristic point of view ‐ that a deterministic outlook will be the decisive support for the psychiatrist in his attempts to comply with the definitive ethical claim: to hold the patient in unlimited respect.

So the biological aspect of psychiatry involves ethical prerogatives and values far beyond and contrary to the current prejudices and contortions characterizing the popular‐populistic view of psychiatry ‐ this regarding the attitude of the physician to the mentally ill patient in person as well as regarding the psychiatrists possibilities of supporting the relatives in their relationship to the sick person.
Blood‐brain barrier studies with special reference to epileptic seizures
Authors: Bolwig Tom G.
Published: August 2010

A review is given of the structure and function of the blood‐brain barier (BBB) with special reference to the situation during and after epileptic seizures including electroconvulsive therapy (ECT). Based on the literature describing different models of epilepsy the development of the theories concerning the early observations of a BBB dysfunction in connection with seizure activity is given, and gross morphology, ultrastructural and dynamic findings are briefly reviewed.
Rating scales for mood disorders: Applicability, Consistency and construct validity
Authors: Bech Per
Published: August 2010

Rating scales for mood disorders have been reviewed with special reference to their consistency, applicability, and validity. Diagnostic scales with a biometric reference to antidepressants have been developed on the basis of the Newcastle Scales. This Diagnostic Melancholia Scale (DMS) includes two dimensions, one measuring endogenous depression, and one measuring reactive depression. These dimensions were found not to be mutually exclusive as 30% of the depressed patients scored high on both dimensions. Scales measuring outcomes of treatment were subdivided into (a) scales measuring disability of clinical depression (melancholia), anxiety, and mania, (b) scales measuring distress as a construct of sideeffects during treatment, and (c) scales measuring discomfort or quality of life. Disability, distress and discomfort should be separately validated as they reflect different aspects of outcome of treatment. Self‐rating scales have their main applicability in the measurement of discomfort.
Psychiatri admissions of the elderly
Authors: Strömgren Erik
Published: August 2010

In 1955 Ole J. Rafaelsen performed an analysis of the admissions of elderly patients to the Aarhus Psychiatric Hospital during the preceding decade. On the basis of nation‐wide statistics the changing rǒle since then of the elderly in the Danish psychiatric hospital system is described.
Imipramine binding in depression and other psychiatric conditions
Authors: Mellerup Erling T. , Plenge Per
Published: August 2010

30 studies of platelet 3H‐imipramine binding in depressed patients are reviewed. 19 of these studies found that depressed patients had lower binding than control persons, whereas 11 studies found no difference. This discrepancy is discussed and it is concluded that methodological problems may account for a substantial part of the low imipramine binding in depressed patients.
Lithium treatment: Are the present schedules optimal?
Authors: Plenge P. , Mellerup E. T.
Published: August 2010

Lithium treatment is a proven and effective prophylactic treatment of bipolar affective disorders. To day patients receive their lithium in one or two daily doses, and the dosage level in the individual patient is adjusted to the lowest possible level in order to reduce side effects. In the present article we suggest an alternative treatment strategy also aiming at reducing side effects but not involving the slow process of finding the lowest possible effective lithium dose. We suggest prophylaxis may be obtained by giving lithium every second day in a dose producing 12 hour serum lithium concentrations between 0.6 and 0.9 mM, and leading to very low lithium concentrations every second day. This treatment schedule is at present being tested in the clinic.
Imipramine: A model substance in pharmacokinetic research
Authors: Gram Lars F.
Published: August 2010

The pharmacokinetics of imipramine have been studied over a period of 20 years. Imipramine is rapidly and almost completely metabolized with the formation of desipramine (desmethylation), 2‐hydroxy metabolites and subsequent glucoronide coupling. Imipramine has a high clearance (0.8‐1.5 1/min) and a corresponding high first pass eliminatin (30‐70%). Volume of distribution is high (650‐1100 1) and half‐lives accordingly of medium length (6‐12 h). The 2‐hydroxylation which is the most important step of elimination is mediated via a microsomal cytochrome P450 isozyme that exhibit monogenetic polymorphism such that 5‐10% of the population have a severely reduced clearance. Co‐administration of neuroleptics may also considerably impair the 2‐hydroxylation. Steady‐state levels of imipramine and desipramine varies considerably among individuals mainly due to variations in metabolism, but also to a smaller extent due to variations in binding to plasma proteins. The variations in steady‐state concentrations appear to have clear implication for the clinical effects of imipramine.
The integrated approach: On the significance of pharmacological and nonpharmacological factors when lithium prophylaxis fails
Authors: Schou M.
Published: August 2010

Drugs are easy to prescribe, and if a manic‐depressive patient is not helped by one prophylactically administered drug, physicians may be apt as a first reaction to prescribe another drug, especially now that alternatives to lithium have become available. This may or may not be the appropriate course of action. Often nonpharmacological factors determine whether patients consume their medicine and whether they respond to it, and concern about patient selection, patient characteristics, treatment execution, patient and therapist attitudes, treatment organization, and supplementary psychological support may more profitably serve to ensure that manic‐depressive patients obtain help from prophylactic drug treatment. Only by employing a treatment approach which integrates pharmacological and nonpharmacological measures can optimal results be obtained.
Anorexia/Bulimia Nervosa: The development of Anorexia Nervosa and of mental symptoms. Treatment and the outcome of the disease
Authors: Bassøe Hans H.
Published: August 2010

Bassøe HH. Anorexia/Bulimia Nervosa: The development of Anorexia Nervosa and of mental symptoms. Treatment and the outcome of the disease.

Acta Psychiatr Scand Suppl. 361, Vol. 82. 1990: 7–13.

Since 1958 we have conducted a prospective study of anorexia/bulimia nervosa (A/BN) covering a total of 550 patients. This paper presents a new idea of the development of A/BN. For a variety of reasons, a predisposition for developing A/BN is triggered by a minor and non‐specific loss of weight. The development of mental symptoms with pathological thoughts and behaviour, and disturbances in the satiety and hunger centres suggest a cerebral dysfunction. Educating patients in pathophysiology enables them to use their intelligence, logical thinking and strong will to evaluate the importance of an adequate supply of nutrients. To date, two studies of the outcome of the disease have been carried out producing similar results: 86% fair results (12% spontaneous recovery), 13% chronic cases and 1% have died.
Individual psychotherapeutic treatment of Anorexia Nervosa*
Authors: Lunn Susanne
Published: August 2010

Lunn S. Individual psychotherapeutic treatment of Anorexia Nervosa. Acta Psychiatr Scand Suppl. 361, Vol. 82. 1990: 23–28.

The first part of this paper presents a review of the many psychiatric diagnoses and different kinds of treatment which have been used in relation to Anorexia Nervosa (AN). The difficulties in solving the enigma of AN are seen as connected with the conception of AN as a specific nosological entity. Contrary to this, AN is conceived as a specific kind of defense characterized by a splitting of the ego, where adaptation to part of reality is given up by means of denial. This less uniform conception makes it possible to encompass the personality trait common to anorectic patients as well as the differences between them. In the second part, the question of whether psychoanalytic psychotherapy is a suitable form of treatment is discussed. The partly affirmative answer is guided by the anorectic girl's own attempt towards a solution, which indicates a need for a protected, neutral, and empathic space, where she gets the opportunity to express and develop herself. However, in many cases neither the physical nor the psychological conditions for establishing a therapeutic alliance is available. Finally, a need for modification in technique is considered.
Group therapy for anorexic and bulimic patients
Authors: Rosenvinge Jan H.
Published: August 2010

Rosenvinge JH. Group therapy for anorexic and bulimic patients. Some aspects on the conduction of group therapy and a critical review of some recent studies

Acta Psychiatr Scand Suppl. 361, Vol. 82. 1990: 38–43.

Group psychotherapy for Anorexia Nervosa (AN) and Bulimia Ner‐vosa (BN) patients may be a major therapeutic challenge. The cognitive‐behavioural approach may seem promising and some important stages in the conduction of cognitive‐behavioural group therapy in particular are discussed. Furthermore, some problems concerning inpatient versus outpatient groups are mentioned. Studies on group therapy that have appeared between 1984 and 1989 are briefly reviewed and some recommendations concerning the improvement of methodology for future studies are put forward.
Eating disorders and the family
Authors: Røgeberg Kristin
Published: August 2010

Røgeberg K. Eating disorders and the family. Experiences gathered in a parent support group.

Acta Psychiatr Scand Suppl. 361, Vol. 82. 1990: 50–51.

The author is a part‐taker in a parent support group at Rikshospitalet in Oslo. The members have different occupations and experiences. This article shows some of the experiences and reflections of the group concerning the subject in question.
Prevalence and risks of pathological gambling in Sweden
Authors: Volberg Rachel A. , Abbott Max W. , Rönnberg Sten , Munck Ingrid M. E.
Published: August 2010

Objective:  This paper presents results from the first national survey of problem gambling completed in Sweden.

Method:  The Swedish survey is unique in its quality and representativeness, due to the use of multiple modes of data collection, recruitment of respondents from national registers rather than from households, and high response rate.

Results:  In spite of high rates of gambling participation in Sweden, the combined prevalence of problem and pathological gambling in Sweden is relatively low (3.9% lifetime and 2.0% current). Multivariate analysis shows that being male, under the age of 25 and born abroad are significant risk factors for lifetime gambling problems in Sweden. Additional risk factors are being single, living in big cities, and receiving social welfare payments.

Conclusion:  The groups most at risk for gambling problems in Sweden are people disadvantaged and marginalized by international economic changes as well as the dismantling of the Swedish welfare system.
Internal consistency, intercriterion overlap and diagnostic efficiency of criteria sets for DSM‐IV schizotypal, borderline, avoidant and obsessive‐compulsive personality disorders
Authors: Grilo Carlos M. , McGlashan Thomas H. , Morey Leslie C. , Gunderson John G. , Skodol Andrew E. , Tracie Shea M. , Sanislow Charles A. , Zanarini Mary C. , Bender Donna , Oldham John M. , Dyck Ingrid , Stout Robert L.
Published: August 2010

Objective: To evaluate performance characteristics of DSM‐IV Personality Disorders (PDs) criteria.

Method: Six hundred and sixty‐eight adults recruited for the Collaborative Longitudinal Personality Disorders Study (CLPS) were assessed with diagnostic interviews.

Results:
Within‐category inter‐relatedness was evaluated by Cronbach's alpha and median intercriterion correlations (MIC). Cronbach's alpha ranged from 0.47 to 0.87 (median=0.71); seven of the 10 PDs had alphas greater than 0.70. Between‐category criterion overlap was evaluated by ‘inter‐category’ intercriterion correlations between all PD pairs (ICMIC). ICMIC values (median=0.08) were lower than MIC values (median=0.23). Diagnostic efficiency statistics (sensitivity, specificity, positive predictive power and negative predictive power were calculated for schizotypal, borderline, avoidant and obsessive‐compulsive PDs.

Conclusion: DSM‐IV PD criteria sets have some convergent validity and discriminant validity: criteria for individual PDs correlate better with each other than with criteria for other PDs. Diagnostic efficiency statistics provide guidance regarding usefulness of criteria for inclusion or exclusion.
Increased expression of epidermal fatty acid‐binding protein by alveolar macrophages during acute rejection of rat lungs
Authors: HOLLER JULIA , ZAKRZEWICZ ANNA , GARN HOLGER , HIRSCHBURGER MARKUS , KUMMER WOLFGANG , PADBERG WINFRIED , GRAU VERONIKA
Published: August 2010

Holler J, Zakrzewicz A, Garn H, Hirschburger M, Kummer W, Padberg W, Grau V. Increased expression of epidermal fatty acid‐binding protein by alveolar macrophages during acute rejection of rat lungs. APMIS 2010; 118: 791–800.

In the lung, epidermal fatty acid‐binding protein (E‐FABP) is expressed by alveolar macrophages (AM) and alveolar epithelial cells type II (AEII). E‐FABP may regulate macrophage activation and is involved in the metabolism of surfactant phospholipids. As macrophage activation and surfactant dysfunction are associated with rejection, we hypothesize that E‐FABP expression is changed during acute rejection of pulmonary grafts. Orthotopic left lung transplantations were performed in the Dark Agouti to Lewis and in the isogeneic Lewis to Lewis rat strain combinations. E‐FABP expression was analyzed in the lung by immunohistochemistry, immunoblotting and quantitative reverse transcription‐polymerase chain reaction (RT‐PCR). Alveolar leukocytes obtained by bronchoalveolar lavage were analyzed by RT‐PCR. Immunohistochemistry of isografts revealed strong E‐FABP immunoreactivity in AEII and a moderate immunoreactivity in AM. In allografts undergoing acute rejection, AM exhibiting increased E‐FABP immunoreactivity accumulated. Immunoblots revealed a single band at 15 kDa, which corresponds to the expected molecular mass of E‐FABP. The levels of E‐FABP mRNA were higher in allografts than in isografts and control lungs. Furthermore, alveolar leukocytes isolated by bronchoalveolar lavage from allografts displayed higher E‐FABP mRNA expression levels than leukocytes from isografts and controls. In conclusion, we demonstrate for the first time upregulation of E‐FABP expression in AM during severe inflammation.
Prevalence and resistance patterns of extended‐spectrum and AmpC β‐lactamase in Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, and Salmonella serovar Stanley in a Korean tertiary hospital
Authors: PARK SOON DEOK , UH YOUNG , LEE GYUSANG , LIM KWANHUN , KIM JONG BAE , JEONG SEOK HOON
Published: August 2010

Park SD, Uh Y, Lee G, Lim K, Kim JB, Jeong SH. Prevalence and resistance patterns of extended‐spectrum and AmpC β‐lactamase in Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, and Salmonella serovar Stanley in a Korean tertiary hospital. APMIS 2010; 118: 801–8.

A total of 100 clinical isolates of Escherichia coli (n = 35), Klebsiella pneumoniae (n = 63), Proteus mirabilis (n = 1), and Salmonella serovar Stanley (n = 1), showing resistance to cefoxitin, or returning positive in extended‐spectrum β‐lactamase (ESBL) by Clinical and Laboratory Standards Institute (CLSI) ESBL confirmatory method, were studied. The isolates were examined by the boronic acid (BA) disk test, polymerase chain reaction, and pulsed‐field gel electrophoresis (PFGE) to investigate genetic similarities. The concurrence rates for ESBLs by the CLSI and the BA disk test were 97% for E. coli and 96.7% for K. pneumoniae. A total of 41 isolates showing cefoxitin resistance yielded all positive by the BA disk test. All the 33 K. pneumoniae isolates, which showed positive by the BA disk test, were carrying AmpC genes. The TEM and CTX‐M types were predominant in E. coli and the SHV and the CIT and/or DHA types were predominant in K. pneumoniae. PFGE analysis showed almost 75% of genetic similarities among K. pneumoniae isolates producing ESBLs and/or AmpC β‐lactamases (AmpCs) as each K. pneumoniae carried variable genes and showed variable antibiotic patterns. Clearly, the BA disk test was a useful method for the detection of ESBLs and AmpCs. In particular, cefoxitin resistance and BA‐positive trait of K. pneumoniae do reflect the presence of AmpC genes in the organism.
Pulse Pressure Independently Predicts Major Cardiovascular Events in Younger But Not in Older Subjects with Erectile Dysfunction
Authors: Corona Giovanni , Monami Matteo , Boddi Valentina , Rastrelli Giulia , Melani Cecilia , Balzi Daniela , Sforza Alessandra , Forti Gianni , Mannucci Edoardo , Maggi Mario
Published: August 2010

Introduction

Pulse pressure (PP; i.e., the arithmetic difference between systolic and diastolic blood pressure) has been suggested to be an independent cardiovascular risk (CV) factor in the general population. We previously also reported a negative association between PP and arteriogenic erectile dysfunction (ED). This finding has recently been questioned.

Aim

To verify the association of PP with ED severity and to evaluate its role in predicting forthcoming CV events.

Methods

This is an observational prospective cohort study evaluating a consecutive series of 1,687 patients attending our Andrological Unit for ED.

Main Outcome Measures

Several hormonal and biochemical parameters were studied, along with SIEDY structured interviews and penile Doppler ultrasound.

Results

Subjects with PP in the lowest quartile (I: 20–45; II: 46–55; III: 56–62; IV: 63–115 mm Hg) had a significant reduction in the risk of severe ED (RR = 0.60[0.47–0.76]; P < 0.0001). When the same analysis was repeated as a function of age quartile (I = 17–44, II = 45–55, III = 56–62, and IV = 63–88 years old), after adjusting for testosterone levels, mean blood pressure, Chronic Disease Score, and body mass index, PP was inversely related to ED only in the youngest age group. During a mean follow up of 4.4 ± 2.6 years, 147 major cardiovascular events (MACE) were observed. In a Cox regression model, after adjusting for possible confounding factors, a lower PP was associated with a lower risk of MACE in the whole sample and in younger subjects, but not in the older ones.

Conclusions

Checking for blood pressure in ED subjects and calculating PP should become a routine practice in sexual medicine. In younger individuals, low PP reflects not only sexual health (better erection) but also cardiovascular health (less prevalence of MACE).