bluuebunny/crossref_metadata_2025 huggingface dataset:
High‐Dose Statin Treatment Does Not Alter Plasma Marker for Brain Cholesterol Metabolism in Patients With Moderately Elevated Plasma Cholesterol Levels
Authors: Thelen Karin M. , Laaksonen Reijo , Päivä Hannu , Lehtimäki Terho , Lütjohann Dieter
Published: June 2006

Statins inhibit endogenous cholesterol synthesis, up‐regulate low‐density lipoprotein (LDL) receptor expression in mammalian liver cells, and thus decrease circulating LDL‐cholesterol concentrations. As cholesterol seems to play a role in the development of neurodegenerative diseases, it is of interest to evaluate the effect of high dosages of statins (eg, atorvastatin or simvastatin) on brain cholesterol metabolism. Plasma samples from 44 participants (aged 30–69 years, 16 men and 18 women) of an earlier randomized, placebo‐controlled, double‐blind trial, who took 40 mg atorvastatin or 80 mg simvastatin daily for 2 months, were used to analyze total cholesterol, its precursor lathosterol, and its metabolites 24(S)‐hydroxycholesterol and 27‐hydroxycholesterol. Despite a significant decrease in absolute plasma concentrations of oxysterols, total cholesterol, and its endogenous synthesis rate, indicated by a decreased ratio of lathosterol to cholesterol, the plasma 24(S)‐hydroxycholesterol to cholesterol ratio, a surrogate marker of brain cholesterol homeostasis, remained unchanged. Short‐term high‐dose atorvastatin and simvastatin treatment does not seem to influence brain cholesterol metabolism in patients with moderately elevated plasma cholesterol levels.
Principals' Knowledge of Fundamental and Current Issues in Special Education
Authors: Wakeman Shawnee Y. , Browder Diane M. , Flowers Claudia , Ahlgrim-Delzell Lynn
Published: June 2006

The purpose of the study is to determine the comprehensive knowledge base of national secondary principals related to special education issues. Using a survey developed from the empirical and conceptual literature for assessing fundamental and current issues in special education, data were collected from a national sample of secondary school principals. Overall, principals report being well informed in fundamental issues. Although the relationship between demographics and knowledge produced mixed results, principal practices have a positive relationship with knowledge of special education issues.
The Value of Teacher Portfolios for Evaluation and Professional Growth
Authors: Attinello Jacqueline R. , Lare Douglas , Waters Faith
Published: June 2006

The demands placed on principals in the era of No Child Left Behind are rapidly increasing. In light of these challenges, balancing diverse roles and additional responsibilities can be arduous for even the finest school leaders. The use of portfolio-based teacher appraisals has emerged as an intriguing option to make the time required for teacher evaluation more productive and the process more meaningful, comprehensive, and accurate. This study examines the value of a district-wide, portfoliobased teacher evaluation system. Results indicate that teachers and administrators perceive that teacher portfolios were more accurate and comprehensive than the traditional snapshot observation and, despite some disadvantages, suggest that portfolios show promise as a tool for teacher evaluation and professional growth.
Teacher Quality and Troops to Teachers: A National Study With Implications for Principals
Authors: Owings William A. , Kaplan Leslie S. , Nunnery John , Marzano Robert , Myran Stephen , Blackburn David
Published: June 2006

A 2005 national study surveyed 2,103 Troops to Teachers (T3) program completers and their school administrators using 21 research-based instructional practices and four effective classroom management strategies associated with increased student achievement to determine whether T3s were more effective in the classroom than traditionally prepared teachers with comparable years of teaching experience. Sixty-one percent returned completed surveys. Principals overwhelmingly (more than 90%) reported that T3s are more effective in classroom instruction and classroom management/student discipline—and have a more positive impact on student achievement—than traditionally prepared teachers. Moreover, T3s teach in high-poverty schools, teach high-demand subjects (special education, math, science), plan to remain in teaching, and increase the teaching pool's diversity.
Academic Leadership in America's Public Schools
Authors: Ervay Stu
Published: June 2006

Academic leadership directly helps faculty members, administrative leaders, and professional support persons improve the quantity and quality of student learning. Those who regularly lead decision-making and action-taking processes in curriculum, instruction, and assessment of student learning can be called academic leaders. This article focuses on the need for improved academic leadership and examines models suggested by the Curriculum Leadership Institute, Southern Regional Education Board, and the Boston School Leadership Institute.
A Review of the Firm-Level Role of Transport Infrastructure with Implications for Transport Project Evaluation
Authors: Holl Adelheid
Published: June 2006

The measurement of the economic impacts of transportation investment is a critical input into the policy process. While most research has focused on aggregate effects, this article critically reviews evidence and arguments surrounding the role of transport infrastructure at the firm level. In addition to how transport investment affects firms’ transport decision directly, there are a number of mechanisms whereby transport investment can affect the location and spatial organization of firms. Such mechanisms can lead to increases of output and productivity and create firm-level benefits beyond the direct transport user benefits considered in traditional project evaluation. Transport project evaluation and transport policy more in general require an understanding of these micro-level transmission mechanisms to correctly guide investment decisions regarding the location and type of future transport projects.
Analysis of Community Pharmacy Workflow Processes in Preventing Dispensing Errors
Authors: Hoxsie DeAnna M. , Keller Amanda E. , Armstrong Edward P.
Published: June 2006

The objectives of this analysis were to determine the compliance rate with dispensing workflow criteria and note if any dispensing errors occurred. Observations were made within 18 community retail pharmacies having at least 50 out-window (ie, prescription pickup window) transactions per store. Based on the historic pharmacy error incidence reports, pharmacies were categorized as being either high- or low-risk pharmacies. The compliance rates for the dispensing workflow criteria were observed between high- and low-risk pharmacies and also between different employee categories. Employee categories included pharmacists, pharmacy interns, and pharmacy technicians who were involved in the dispensing process. Between August 2004 and January 2005, 950 out-window transactions were observed. There were statistically significant differences seen between high- and low-risk pharmacies and between the various categories of employees. Based on this study, the lack of the verification of patient's name and number of prescriptions being picked up was the procedure that was more commonly associated with pharmacies reported to have high dispensing error rates.
Management of Dyslipidemia in Special Populations
Authors: Tovar John M. , Schering Debora B.
Published: June 2006

Dyslipidemia is a significant contributor to morbidity and mortality in the industrialized world. Because it is often intertwined with other medical conditions, its management is becoming progressively more complex. Populations that pose a particular challenge to clinicians include diabetic patients, children and adolescents, elderly persons, transplant patients, patients with the human immunodeficiency virus, and patients with chronic kidney disease. When establishing lipid goals, it is imperative to have a thorough understanding of the evidence, or lack thereof, supporting the use of lipid-lowering agents among these patients. To maximize the benefits and minimize the risks of pharmacological intervention, clinicians must consider not only the unique alterations in the lipid profile of the aforementioned populations but also individual changes in patients' pharmacokinetic and pharmacodynamic parameters, as well as the potential for drug-drug and drug-disease interactions.
Role of the Pharmacist in the Management of Dyslipidemia
Authors: Olson Kari L. , Potts Lisa A.
Published: June 2006

Dyslipidemia is one of a number of independent risk factors for cardiovascular disease. Numerous large-scale, randomized clinical trials demonstrate the benefit of aggressive lipid-modifying therapy in reducing the mortality and morbidity associated with cardiovascular disease. Despite these data and the wide dissemination of clinical practice guidelines outlining management strategies for patients with dyslipidemia, particularly those at the greatest cardiovascular risk, studies indicate that a significant proportion of patients are not screened, initiated on appropriate therapy, or treated to target lipid levels. Pharmacists, as part of the multidisciplinary team, can play a vital role in assisting in the management of patients with dyslipidemias. This article reviews published studies that have evaluated the pharmacist's role in lipid management, reviews the process for managing a patient with dyslipidemia, and provides suggestions on how pharmacists can become more involved in lipid management.
The Changing Face of Dyslipidemia Therapies
Authors: Rochester Charmaine D. , Cooke Catherine E.
Published: June 2006

To date, the major emphasis of dyslipidemia management has focused on the reduction of serum low-density lipoprotein cholesterol (LDL-C) levels, which several robust trials show significantly decreases the risk of coronory heart disease (CHD). To achieve goal LDL-C levels will require that some individuals take more than 1 cholesterol-lowering medication. In addition, many dyslipidemic patients also have concomitant risk factors for cardiovascular disease including hypertension, elevated plasma glucose, and high body mass index, requiring additional therapies. In addition to drugs that lower LDL-C, several agents under investigation are targeting other markers for decreasing the risk of atherosclerotic disease. Some of these agents target the reduction of C-reactive protein with a more potent statin, increased high-density lipoprotein cholesterol (HDL-C) with the cholesterol ester transfer protein inhibitor, inhibition of triglyceride or very-low-density lipoprotein cholesterol (VLDL-C) with the acyl coenzyme A: cholesterol acyltransferase inhibitor, reduction of VLDL-C with microsomal triglyceride transfer protein inhibitor, change in percentage coronary atheroma volume with HDL-C mimetics, and the reduction of bile acid transport and reabsorption with the ileal bile acid transport inhibitors. This review will provide an overview of the existing landscape for the medical treatment of dyslipidemia, including available therapies and future trends.
What's New? Guidelines and Goals
Authors: Wigle Patricia R. , Birtcher Kim K.
Published: June 2006

Several expert panels have written guidelines regarding the treatment of dyslipidemias. The recommendations from the National Cholesterol Education Program (NCEP); American Diabetes Association (ADA); American Heart Association (AHA); National Heart, Blood, and Lung Institute (NHBLI); and National Kidney Foundation (NKF) will be reviewed. The guidelines agree on several points: using the fasting lipid panel as the initial screening tool, targeting low-density lipoprotein cholesterol (LDL-C) initially, and achieving lower LDL-C goals. Some guidelines are more aggressive than those of the NCEP: the ADA and AHA have defined low high-density lipoprotein cholesterol as <50 mg/dL for women; the ADA recommends a need for drug therapy when the patient's total cholesterol, rather than LDL-C, is ≥135 mg/dL for patients who are older than 40 years; the NKF and the AHA have classified patients with chronic kidney disease in the high-risk category; and the AHA has revised the diagnostic criteria for metabolic syndrome to include additional people. More patients are qualifying for lifestyle modifications and medication treatment. A subset of these patients may require combination cholesterol-lowering medications to reach the new goals. Pharmacists will need to keep current with the literature and be knowledgeable about the guidelines to maximize the care given to our patients.
An Examination of Psychiatric-Mental Health Outcomes From the Perspectives of Logical Positivism and Phenomenology
Authors: Kutney Ann M.
Published: June 2006

The current philosophical paradigm in psychiatry is based in logical positivism, as outcomes are viewed as objective and scientifically verifiable. This approach, although making important contributions to the field, fails to acknowledge outcomes from the perspective of the client. A growing movement within the mental health field is promoting the use of phenomenology and the lived experience, which provides new opportunities for defining outcomes from the client’s perspective. The purpose of this article is to briefly review the main tenets of both philosophical perspectives and to demonstrate how these perspectives influence the conceptualization of outcomes in psychiatric-mental health nursing practice and research. Finally, a proposal is made for clinicians and researchers to adopt an integrative model, a blending of the two viewpoints, to capture the most complete experience of the client and to define the most appropriate outcomes.
Enhancing Participant Recruitment in Studies of Sensitive Topics
Authors: Records Kathie , Rice Michael
Published: June 2006

Recruiting participants in studies involving sensitive topics can be challenging. OBJECTIVE This article examines whether a modified application of the Dillman method for enhancing survey response rates will increase participant recruitment rates when studying abuse during childbearing. STUDY DESIGN Bilingual informed consents (N =676) were mailed from 10 obstetrician, midwife, and family practice offices. Return of a signed informed consent enrolled the participant in the study. Informed consents were sent a maximum of three times to nonresponders. RESULTS Application of the modified Dillman method improved the recruitment rate from 13% to 35%, but only 16% of the sample had experienced abuse. CONCLUSION The data provide initial evidence supporting using this methodology for increasing sample recruitment. Further study is necessary to identify whether the characteristics of participants responding to the first mailing differ from the characteristics of those who respond to subsequent mailings.
A Cartesian Reflex Assessment of Face Processing
Authors: Polewan Robert J. , Vigorito Christopher M. , Nason Christopher D. , Block Richard A. , Moore John W.
Published: June 2006

Commands to blink were embedded within pictures of faces and simple geometric shapes or forms. The faces and shapes were conditioned stimuli (CSs), and the required responses were conditioned responses, or more properly, Cartesian reflexes (CRs). As in classical conditioning protocols, response times (RTs) were measured from CS onset. RTs provided a measure of the processing cost (PC) of attending to a CS. A PC is the extra time required to respond relative to RTs to unconditioned stimulus (US) commands presented alone. They reflect the interplay between attentional processing of the informational content of a CS and its signaling function with respect to the US command. This resulted in longer RTs to embedded commands. Differences between PCs of faces and geometric shapes represent a starting place for a new mental chronometry based on the traditional idea that differences in RT reflect differences in information processing.
School climate, sense of efficacy and Israeli teachers’ attitudes toward inclusion of students with special needs
Authors: Weisel Amatzia , Dror Orit
Published: June 2006

This article examines the effects of school organizational and educational climate, and a teacher’s sense of efficacy, on general education teachers’ attitudes toward inclusion of students with special needs. The sample included 139 teachers from 17 elementary schools in the Northern District of Israel. The results of Pearson correlation and multiple regression analyses indicated that school climate and teachers’ sense of efficacy as well as participation in special education training were positively associated with teachers’ attitudes toward inclusion. Self-efficacy was the single most important factor affecting attitudes. School climate included six factors: supportive leadership; teachers’ autonomy; prestige of the teaching profession; renovations; teachers’ collaboration; and workload. Examination of the intercorrelations among these factors and with attitudes revealed that those teachers who perceived their school as having supportive leadership, encouraged renovations and collaboration but did not threaten teachers’ autonomy, tended to express more positive attitudes towards inclusion.
Education for citizenship
Authors: Astiz M. Fernanda , Mendez Gabriela
Published: June 2006

This article considers how Argentina produces its citizens following its transition to democracy in the early 1980s. We ask how the schooling system is preparing the next generation to participate in the democratic political process, and the responsibilities of nation building in a world that has become more politically and economically entangled. The study reported here engages in content analyses of 1990s education law, curriculum standards and textbooks used in Argentina’s schools.
Rac1 links leading edge and uropod events through Rho and myosin activation during chemotaxis
Authors: Pestonjamasp Kersi N. , Forster Carol , Sun Chunxiang , Gardiner Elisabeth M. , Bohl Ben , Weiner Orion , Bokoch Gary M. , Glogauer Michael
Published: June 2006

Chemotactic responsiveness is crucial to neutrophil recruitment to sites of infection. During chemotaxis, highly divergent cytoskeletal programs are executed at the leading and trailing edge of motile neutrophils. The Rho family of small GTPases plays a critical role in cell migration, and recent work has focused on elucidating the specific roles played by Rac1, Rac2, Cdc42, and Rho during cellular chemotaxis. Rac GTPases regulate actin polymerization and extension of the leading edge, whereas Rho GTPases control myosin-based contraction of the trailing edge. Rac and Rho signaling are thought to crosstalk with one another, and previous research has focused on mutual inhibition of Rac and Rho signaling during chemotaxis. Indeed, polarization of neutrophils has been proposed to involve the activity of a negative feedback system where Rac activation at the front of the cell inhibits local Rho activation, and vice versa. Using primary human neutrophils and neutrophils derived from a Rac1/Rac2-null transgenic mouse model, we demonstrate here that Rac1 (and not Rac2) is essential for Rho and myosin activation at the trailing edge to regulate uropod function. We conclude that Rac plays both positive and negative roles in the organization of the Rhomyosin “backness” program, thereby promoting stable polarity in chemotaxing neutrophils.
B-chronic lymphocytic leukemia cells and other B cells can produce granzyme B and gain cytotoxic potential after interleukin-21-based activation
Authors: Jahrsdörfer Bernd , Blackwell Sue E. , Wooldridge James E. , Huang Jian , Andreski Melinda W. , Jacobus Laura S. , Taylor Christiana M. , Weiner George J.
Published: June 2006

B cells currently are not viewed as being capable of producing granzyme B or being cytotoxic. We found that B-chronic lymphocytic leukemia (B-CLL) cells treated with interleukin-21 (IL-21) produce low levels of granzyme B. The addition of either CpG oligodeoxynucleotide (ODN) or anti-B-cell-receptor antibody (anti-BCR) to IL-21 results in enhanced production of functional granzyme B by B-CLL cells. B-CLL cells treated with IL-21 and CpG ODN undergo apoptosis and are able to induce apoptosis of untreated bystander B-CLL cells. This effect can be inhibited by anti-granzyme B antibody. Benign human B cells, Epstein-Barr virus (EBV)-transformed lymphoblasts, and many standard lymphoma cell lines produce high levels of granzyme B in response to IL-21 and anti-BCR. Our results suggest that the ability to induce production of functional granzyme B by B cells could open new approaches to the therapy of B-CLL and other B-cell malignancies. Our findings also have significant implications for our understanding of the role of B cells for immune regulation and for a variety of immune phenomena, including cancer immunity, autoimmunity, and infectious immunity.
Specific killing of multiple myeloma cells by (-)-epigallocatechin-3-gallate extracted from green tea: biologic activity and therapeutic implications
Authors: Shammas Masood A. , Neri Paola , Koley Hemanta , Batchu Ramesh B. , Bertheau Robert C. , Munshi Vidit , Prabhala Rao , Fulciniti Mariateresa , Tai Yu tzu , Treon Steven P. , Goyal Raj K. , Anderson Kenneth C. , Munshi Nikhil C.
Published: June 2006

Epigallocatechin-3-gallate (EGCG), a polyphenol extracted from green tea, is an antioxidant with chemopreventive and chemotherapeutic actions. Based on its ability to modulate growth factor-mediated cell proliferation, we evaluated its efficacy in multiple myeloma (MM). EGCG induced both dose- and time-dependent growth arrest and subsequent apoptotic cell death in MM cell lines including IL-6-dependent cells and primary patient cells, without significant effect on the growth of peripheral blood mononuclear cells (PBMCs) and normal fibroblasts. Treatment with EGCG also led to significant apoptosis in human myeloma cells grown as tumors in SCID mice. EGCG interacts with the 67-kDa laminin receptor 1 (LR1), which is significantly elevated in myeloma cell lines and patient samples relative to normal PBMCs. RNAi-mediated inhibition of LR1 resulted in abrogation of EGCG-induced apoptosis in myeloma cells, indicating that LR1 plays an important role in mediating EGCG activity in MM while sparing PBMCs. Evaluation of changes in gene expression profile indicates that EGCG treatment activates distinct pathways of growth arrest and apoptosis in MM cells by inducing the expression of death-associated protein kinase 2, the initiators and mediators of death receptor-dependent apoptosis (Fas ligand, Fas, and caspase 4), p53-like proteins (p73, p63), positive regulators of apoptosis and NF-κB activation (CARD10, CARD14), and cyclin-dependent kinase inhibitors (p16 and p18). Expression of related genes at the protein level were also confirmed by Western blot analysis. These data demonstrate potent and specific antimyeloma activity of EGCG and provide the rationale for its clinical evaluation.
Coordination between CCR7- and CCR9-mediated chemokine signals in prevascular fetal thymus colonization
Authors: Liu Cunlan , Saito Fumi , Liu Zhijie , Lei Yu , Uehara Shoji , Love Paul , Lipp Martin , Kondo Shunzo , Manley Nancy , Takahama Yousuke
Published: June 2006

Thymus seeding by T-lymphoid progenitor cells is a prerequisite for T-cell development. However, molecules guiding thymus colonization and their roles before and after thymus vascularization are unclear. Here we show that mice doubly deficient for chemokine receptors CCR7 and CCR9 were defective specifically in fetal thymus colonization before, but not after, thymus vascularization. The defective prevascular fetal thymus colonization was followed by selective loss of the first wave of T-cell development generating epidermal Vγ3+ γδ T cells. Unexpectedly, CCL21, a CCR7 ligand, was expressed not by Foxn1-dependent thymic primordium but by Gcm2-dependent parathyroid primordium, whereas CCL25, a CCR9 ligand, was predominantly expressed by Foxn1-dependent thymic primordium, revealing the role of the adjacent parathyroid in guiding fetal thymus colonization. These results indicate coordination between Gcm2-dependent parathyroid and Foxn1-dependent thymic primordia in establishing CCL21/CCR7- and CCL25/CCR9-mediated chemokine guidance essential for prevascular fetal thymus colonization.
Hospital doctors' attitudes towards palliative care in Germany
Authors: Schneider Nils , Ebeling Heike , Amelung Volker Eric , Buser Kurt
Published: June 2006

Experts from different areas strongly criticize the current level of palliative care in Germany, both inpatient and home care services. Apart from the experts' opinions, little is known in this context about the perspectives of hospital doctors working in different disciplines, such as surgery, internal medicine, gynaecology or anaesthesia. These doctors presumably treat many incurably ill patients with palliative care needs, but they usually have very little experience in palliative medicine. Their attitudes are particularly important because they are affected by the criticism and by future improvement strategies. To study their viewpoints, questionnaire surveys in five hospitals in the federal state of Brandenburg were performed, with 203 (69%) physicians participating. The results showed that the level of palliative care in hospitals was graded better than in the home care setting. Main needs for improvement were seen in the psychosocial support services and in the co-operation with outpatient services. In aspects of care the hospital physicians' view, palliative nursing care was of a higher standard than medical knowledge of issues. The physicians showed great interest in improving their palliative care and in new specialist palliative care services. The conclusions were that three main strategies for improvement should be embarked on: (1) the establishment of integrated care systems to overcome financial and structural barriers between in-and outpatient care; (2) the establishment of further specialist palliative care services (eg, hospital-based palliative care teams); and (3) better education in palliative medicine.
Impact of a postgraduate six-month rotation in palliative care on knowledge and attitudes of junior residents
Authors: Duong Phuc H , Zulian Gilbert B
Published: June 2006

Fifty junior residents completed a six-month training period. An anonymous postal questionnaire was sent to collect the residents' opinions on improvements in their knowledge, perception of priorities and usefulness of training. Responses were rated from 5 (a great deal) to 1 (not at all improved).

A total of 33 (66%) questionnaires were returned. A mean score of 4.48 was obtained on general improvement of knowledge, 4.91 ± 0.29 on pain control, 4.17 ± 0.58 on neurological symptoms, 4.09 ± 0.77 on psychological symptoms, 4.64 ± 0.60 on communication skills and 4.4 ± 0.91 on physician attitudes. Some 58% of residents began the training with apprehension, 85% outlined their priorities and 76% reached these objectives. A total of 70% were fully satisfied with the tuition and support received and 98% recommended such clinical rotation.

Data suggest that a six-month rotation in palliative care results in high levels of perception of improvement in knowledge and satisfaction. Exposure to palliative care patients during clinical rotations in specialized centres must be encouraged.
Grief support provided to caregivers of palliative care patients in Spain
Authors: Yi Patricia , Barreto Pilar , Soler Carmen , Fombuena Miguel , Espinar Victoria , Pascual Lorenzo , Navarro Ramón , González Remedio , Bernabeu Jordi , Suárez Jesús
Published: June 2006

Grief support for relatives of patients in palliative care is recognized as a fundamental practice within palliative medicine. The aim of this research was to determine the nature and extent of grief support programs offered to relatives of patients in palliative care in Spain. A postal survey was carried out among members of the Spanish Society of Palliative Care. The members' names were obtained through the Society's 2000 Directory, which lists 160 different teams, of which 50% answered a questionnaire made up of 34 questions, some open-ended and others multiple choice. Results show that 88.6% of the services include grief support, that mainly emotional and one-to-one care is provided (92.4 and 89.9%, respectively), and that the number of psychologists and social workers in each team is limited. The risk factors most commonly taken into account by professionals are: absence of family support (36.92%) and the bereaved's case history (21.54%); while the most widely used diagnostic criteria for complicated bereavement are blame and depression (12.5 and 11.36%). In conclusion, it can be seen that bereavement services are not completely consolidated in Spain and there is a need for a greater variety of intervention strategies.
Does persistent involvement by the GP improve palliative care at home for end-stage cancer patients?
Authors: Aabom Birgit , Kragstrup Jakob , Vondeling Hindrik , Bakketeig Leiv S , Stovring Henrik
Published: June 2006

Objective: To analyse the effect of GP home visits on the granting of a terminal declaration (TD) and on place of death. Participants and design: A total of 2025 patients with cancer as the primary cause of death in the period 1997-1998, were investigated in a mortality follow-back design using the Danish Cancer Register and four administrative registers. The Danish TD can be issued by a physician for patients with an estimated prognosis of six months or less. The TD gives the right to economic benefits and increased care for the dying patient. Setting: The island of Funen/Denmark. Main outcome measures: Main outcome hospital death. Intermediate outcome TD. Results: A total of 38% of patients received a TD and 56% died in hospital. GP home visits in the week before TD (odds ratio (OR): 16.8; 95% CI: 8.2-34.4), as well as four weeks before TD (OR: 6.4; 95% CI: 4.5-9.2) were associated with an increased likelihood of receiving a TD. GP home visits in the group with TD (OR: 0.18; 95% CI: 0.11-0.29) and the group without TD (OR: 0.08; 95% CI: 0.05-0.13) was inversely associated with hospital death. A dose-response relationship was found in both groups. Conclusion: Persistent involvement by the GP is associated with improved end-of-life care for cancer patients. Provided that temporal relations are taken into account, the mortality follow-back design can be a suitable and ethical research method to highlight and monitor end-of-life cancer care.
End-of-life care in community hospitals: the perceptions of bereaved family members
Authors: Hawker Sheila , Kerr Chris , Payne Sheila , Seamark David , Davis Carol , Roberts Helen , Jarrett Nicola , Roderick Paul , Smith Helen
Published: June 2006

Objectives: The perceptions of bereaved family members were obtained to evaluate the nature and quality of end-of-life care in community hospitals. Design: During organizational case studies in six community hospitals in the South East and South West of England, bereaved family members were asked to participate in semi-structured interviews. Participants: Fifty-one interviews were conducted with family members of patients who had received end-of-life care in a community hospital within the previous year. Results: Respondents were very positive about the care they and the patient had received. They valued the convenience of access for frequent and long-stay visiting and the familiarity of the local hospital. Comparisons were made with more negative experiences at their nearest District General Hospital. Issues raised included the noise at the community hospitals, and the lack of contact with qualified nurses. Discussion: The results of this study have implications for UK government initiatives, such as the National Framework for Older People,1 and the Department of Health's ‘Keeping the NHS Local’2.
The evolving randomised controlled trial in mental health: studying complexity and treatment process
Authors: Green Jonathan
Published: June 2006

As a gold-standard methodology for the testing of the effectiveness of health treatments, the randomised controlled trial (RCT) continues to evolve to meet the challenges of new contexts and areas of medicine. This article reviews two particular evolving features of RCTs that make them increasingly well adapted to testing psychological interventions in mental health. The first is a new confidence that RCTs can be successfully adapted to test the more complex (often psychosocial) health interventions and technologies. The second is an increasing emphasis on using the RCT method to explore many facets of the process of treatment as well as its outcome. These two developments should help the RCT method to come of age in mental health, increase the face validity of the RCT method for practitioners and aid the effective translation of research work into improvements in practice.
Something out of nothing: the placebo effect
Authors: Vallance Aaron K.
Published: June 2006

The history of the concept of the placebo effect and research into its quantification and mechanisms are reviewed, particularly in relation to psychiatry. Research has demonstrated a notable placebo effect in depression: a large proportion of the clinical effect of antidepressant medication is attributable to the effect. Various mechanisms have been hypothesised: anxiety relief, expectation, transference, ‘meaning effects' and conditioning. Recent research from neuroimaging has unveiled that the effect is associated with biological correlates in the brain. Despite the renewal of research into the placebo effect, many questions remain unanswered. This partly reflects philosophical obstacles such as the mind/body dichotomy, which are inherent in conceptualising the effect. However, it also demonstrates the vast scope for further research into this area. Ultimately, an understanding of the processes that underlie the placebo effect should allow a rationalised therapeutic approach to be developed to maximise the clinical benefit of the therapeutic encounter.
Violence and psychiatric morbidity in the national household population of Britain: public health implications
Authors: Coid Jeremy , Yang Min , Roberts Amanda , Ullrich Simone , Moran Paul , Bebbington Paul , Brugha Traolach , Jenkins Rachel , Farrell Michael , Lewis Glyn , Singleton Nicola
Published: June 2006

Background

It is unclear whether psychiatric morbidity contributes to the small proportion of the population responsible for a large percentage of antisocial behaviour, including violence.

Aims

To measure associations between psychiatric morbidity and severity chronicity and types of victims of violence in the national household population of Britain.

Method

Cross-sectional survey of persons in households (n=8397). Data included self-reported location, victims and outcome of violence over the previous 5 years. Diagnoses were determined by computer-assisted interviews.

Results

Hazardous drinking was associated with over half of all incidents involving injury. Antisocial personality disorder conveyed an attributable risk of 24% of respondents reporting victim injuries, but screening positive for psychosis conveyed an attributable risk of only 1.2%.

Conclusions

The burden of care resulting from violence associated with hazardous drinking supports population interventions. Despite exceptional risks, half of respondents with antisocial personality disorder were not violent, indicating limitations in targeted interventions to detain high-risk individuals.
Generalisability of the individual placement and support model of supported employment: results of a Canadian randomised controlled trial
Authors: Latimer Eric A. , Lecomte Tania , Becker Deborah R. , Drake Robert E. , Duclos Isabelle , Piat Myra , Lahaie Nicole , St-Pierre Marie-Sylvie , Therrien Claude , Xie Haiyi
Published: June 2006

Background

Studies conducted in the USA have found the individual placement and support model of supported employment to be more effective than traditional vocational rehabilitation at helping people with severe mental illness to find and maintain competitive employment.

Aims

To determine the effectiveness of the individual placement and support (supported employment) model in a Canadian setting.

Method

A total of 150 adults with severe mental illness, who were not currently employed and who desired competitive employment, were randomly assigned to receive either supported employment (n=75) or traditional vocational services (n=75).

Results

Over the 12 months of follow-up, 47% of clients in the supported employment group obtained at least some competitive employment, v. 18% of the control group (P<0.001). They averaged 126 h of competitive work, v. 72 inthe control group (P<0.001).

Conclusions

Supported employment proved more effective than traditional vocational services in a setting significantly different from settings in the USA, and may therefore be generalised to settings in other countries.
Vascular risk factors and incident late-life depression in a Korean population
Authors: Kim Jae-Min , Stewart Robert , Kim Sung-Wan , Yang Su-Jin , Shin Il-Seon , Yoon Jin-Sang
Published: June 2006

Background

Causal relationships between vascular factors and late-life depression are controversial.

Aims

To investigate prospective associations between risk factors for vascular disease and incidence of late-life depression.

Method

Of 661 community participants aged 65 years or over, without depression at baseline, 521 (79%) were re-evaluated 2 years later. At baseline and follow-up, a diagnostic interview for depression was carried out and information on vascular status, disability and cognitive function was gathered.

Results

Pre-existing heart disease, incident stroke and lower baseline high-density lipoprotein cholesterol level were significantly associated with incidence of late-life depression, independently of disability and cognitive function.

Conclusions

These results provide some support for a vascular aetiology of late-life depression. However, important risk factors for cerebrovascular disease such as hypertension and diabetes were not implicated, and the associations with lipid levels might still be explained by affective states earlier in life.
Initial treatment phase in early psychosis: can intensive home treatment prevent admission?
Authors: Gould Matthew , Theodore Kate , Pilling Stephen , Bebbington Paul , Hinton Mark , Johnson Sonia
Published: June 2006

Aims and Method

The aim of this study was to describe the early treatment phase in first-episode psychosis in an area with well-established crisis resolution teams. Socio-demographic characteristics and patterns of initial treatment were investigated for all individuals with first-episode psychosis identified prospectively over a 1-year period in two London boroughs.

Results

Over a year, 111 people presented with first-episode psychosis. Fifty-one people (46%) were initially managed in the community, with the remaining 60 (54%) admitted to in-patient units immediately. By 3 months after presentation, a total of 80 people (72%) had been admitted and 54 (49%) had been compulsorily detained under the Mental Health Act 1983. Thirty-three people were initially managed by the crisis resolution teams and 15 of these were eventually admitted.

Clinical Implications

In a catchment area in which alternatives to admission are well developed, the admission rate for first-episode psychosis was still high.
Diagnosis and management of attention-deficit hyperactivity disorder in children and adults with and without learning disability
Authors: Buckley Sarah , Dodd Philip , Burke Amanda , Guerin Suzanne , McEvoy John , Hillery John
Published: June 2006

Aims and Method

Anecdotal evidence suggests that attention-deficit hyperactivity disorder (ADHD) is underdiagnosed in adults and people of all ages with learning disability. This study examines the clinical practice of Irish consultant psychiatrists when assessing and treating symptoms of ADHD in children and adults with and without a learning disability. A postal questionnaire was sent to 302 consultant psychiatrists working in Ireland.

Results

Ninety-seven consultants (32%) responded, 62 working in general adult psychiatry, 23 in child and adolescent psychiatry and 12 in learning disability. Overall, respondents were more confident about making a diagnosis of ADHD in people without a learning disability. Those working with children were significantly more confident in diagnosing and treating ADHD than those working with adults, irrespective of whether the patient had a learning disability.

Clinical Implications

There is general agreement that symptoms of ADHD exist in children and adults both with and without a learning disability. It is likely that ADHD may be undertreated in patients with learning disability, especially in the adult population.
Violence, stigma and psychiatric diagnosis: the effects of a history of violence on psychiatric diagnosis
Authors: Clark Tom , Rowe Renarta
Published: June 2006

Aims and Method

The aim of the study was to investigate whether psychiatrists consider that patients with schizophrenia present a greater risk of violence than patients with other forms of mental illness. Two pairs of clinical vignettes were devised. In each pair, one contained a history of violence and one did not. One vignette was mailed to each of 2000 consultant psychiatrists in the UK. Respondents were asked to give a preferred diagnosis. Rates of diagnosis of bipolar disorder, schizoaffective disorder and schizophrenia were compared within vignette pairs.

Results

For each pair of vignettes, the rate of diagnosis of schizophrenia was higher (33v.21.5%,P=0.008 and 44.4v.32.1%,P=0.011), and the rate of diagnosis of bipolar disorder was lower (44.2v.62.6%,P<0.0005 and 34.9v.49.3%,P=0.004), among those who received the vignette containing a history of violence.

Clinical Implications

A history of violence may lead to an increased likelihood of receiving a diagnosis of schizophrenia as opposed to bipolar affective disorder. This bias in diagnostic decision-making may affect the treatment received by a patient and may perpetuate and exacerbate the stigma associated with a diagnosis of schizophrenia.
Validation of a short instrument to measure stigmatised attitudes towards mental illness
Authors: Luty Jason , Fekadu Daniel , Umoh Okon , Gallagher John
Published: June 2006

Aims and Method

One of the steps to change stigmatised attitudes involves identifying the concerns of people whose attitude is to be changed. This paper presents the Attitudes to Mental Illness Questionnaire (AMIQ), a short instrument aimed at systematically obtaining this information, and examines the feasibility, test–retest reliability as well as face and construct validity of the AMIQ on the UK general public. A postal survey of a random sample of 1079 adults was conducted. A self-reported questionnaire with 5-point Likert scale responses was validated in response to short fictional vignettes. A second subsample of 256 was used for a reliability test.

Results

The AMIQ is a short instrument with good psychometric properties. It shows good stability, test–retest reliability, alternative test reliability, face, construct and criterion validity. The self-selecting sample of 1079 UK adults showed highly stigmatised attitudes to people with addictive disorders but more positive attitudes to those with depression or self-harm. Results from a smaller follow-up sample showed that attitudes towards people with alcohol dependence and schizophrenia were intermediate.

Clinical Implications

The AMIQ can be used in various medical and mental health stigma research and intervention settings.
A survey of liaison psychiatry services in general hospitals and accident and emergency departments: do we have the balance right?
Authors: Kewley Tamsin , Bolton Jim
Published: June 2006

Aims and Method

By use of a telephone survey, we aimed to investigate liaison psychiatry services of all 29 general hospitals in Greater London. We specifically enquired about services to accident and emergency (A&E) departments.

Results

We identified wide variations in staffing, working hours and patient groups seen. Fourteen services (48%) worked over 24 h and 4 (14%) had specific A&E teams. Twelve services (41%) had established or planned working links with community crisis services.

Clinical Implications

Generally staff numbers fell below national recommendations and there were frequent gaps in service provision. The recent focus on emergency care has lead to an increase in A&E services, but there is a risk that liaison psychiatry services for other general hospital patients are being neglected.
Knowledge of deep vein thrombosis among intravenous drug misusers
Authors: Williams Karen , Abbey Emma
Published: June 2006

Aims and Method

All patients attending the local supervised drug consumption clinics were surveyed over a month. They were asked via a questionnaire to list the risks of injecting drugs, particularly the symptoms and consequences of deep vein thrombosis (DVT). Of 69 patients surveyed, 46 agreed to take part.

Results

Only 9 patients (20%) had never injected drugs, whereas 16 (43%) of those injecting had injected into the groin; 10 patients (22%) had experienced a venous thrombosis themselves, and 35 (76%) knew of someone who had. Only 30 (65%) knew what a clot or thrombosis was. Pain and swelling were the most commonly reported symptoms, but few drug misusers knew of other symptoms. The best informed were those who had experienced thrombosis themselves recently.

Clinical Implications

The results indicate an apparent lack of basic knowledge about the risks of DVT in this sample of drug misusers, and a need for some new initiatives to address health education in this area for all drug misusers.
Service innovations: redesigning a community mental health team
Authors: Shajahan Polash , Forde Frances , McIntosh Mary , Moffat Vicki , Munogee Pravin
Published: June 2006

Aims and Method

We describe the redesign of a community mental health team in Lanarkshire (the focused intervention team for Bellshill). Their remit is to provide focused, time-limited therapeutic intervention for patients with mild-to-moderate mental health problems.

Results

The redesign involved a closer working relationship with the psychiatrist, establishing a concurrent community psychiatric nurse/ psychiatric clinic, recategorisation of ‘soon’ and routine referrals to the team, opt-in letters and the introduction of new assessment formats.

Clinical Implications

These measures combined to provide a shorter waiting list, increased joint working and management plans for patients. Team functioning and morale improved.
Effectiveness of the research day in psychiatric training: survey of consultant psychiatrists
Authors: Okolo Dennis , Ogundipe Laofe O.
Published: June 2006

Aims and Method

We explored the views of consultant psychiatrists (trainers and non-trainers) on the effectiveness of the research day. We sent out postal questionnaires to consultant psychiatrists in general adult and old age psychiatry in the West Midlands to evaluate their own experience of the research day and how useful they felt it was.

Results

The survey had a response rate of 72% (88 out of 122) and the majority of respondents had a positive view of their experience (31 trainers, 60%; 25 non-trainers, 69%). However, more consultant trainers (37, 71%) compared with non-trainers (15, 42%) felt that the research day in its current format should be modified.

Clinical Implications

The research day is useful for the training of specialist registrars and our study confirms this view from the consultants surveyed. Some improvement is required in order for specialist registrars to obtain optimal benefit. We make some suggestions for improving the day's effectiveness.