bluuebunny/crossref_metadata_2025 huggingface dataset:
Medicines used in respiratory diseases only seen in children
Authors: Lenney W. , Boner A. L. , Bont L. , Bush A. , Carlsen K-H. , Eber E. , Fauroux B. , Götz M. , Greenough A. , Grigg J. , Hull J. , Kimpen J. , Sánchez Luna M. , de Benedictis F. M.
Published: August 2009

Detailed literature searches were carried out in seven respiratory disease areas. Therapeutic evidence for efficacy of medicinal products was assessed using the Grades of Recommendation, Assessment and Evaluation (GRADE) methodology, as well as an assessment of safety and side-effects.

Systemic corticosteroids may reduce the development of bronchopulmonary dysplasia but have serious side-effects. Antioxidants need further study to demonstrate whether they have long-term benefits. Treatments for acute bronchiolitis have shown little benefit but new antiviral and monoclonal antibodies need further assessment. Well-constructed studies are needed to confirm the value of inhaled corticosteroids and/or montelukast in the management of viral-induced wheeze. Corticosteroids are the treatment of choice in croup. Minimal or no information is available for the treatment of congenital lung abnormalities, bronchiolitis obliterans and interstitial lung disease.
What defines airflow obstruction in asthma?
Authors: Cerveri I. , Corsico A. G. , Accordini S. , Cervio G. , Ansaldo E. , Grosso A. , Niniano R. , Tsana Tegomo E. , Antó J. M. , Künzli N. , Janson C. , Sunyer J. , Svanes C. , Heinrich J. , Schouten J. P. , Wjst M. , Pozzi E. , de Marco R.
Published: August 2009

Asthma guidelines from the Global Initiative for Asthma (GINA) and from the National Heart, Lung, and Blood Institute provide conflicting definitions of airflow obstruction, suggesting a fixed forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) cut-off point and the lower limit of normality (LLN), respectively. The LLN was recommended by the recent American Thoracic Society/European Respiratory Society guidelines on lung function testing. The problem in using fixed cut-off points is that they are set regardless of age and sex in an attempt to simplify diagnosis at the expense of misclassification.

The sensitivity and specificity of fixed FEV1/FVC ratios of 0.70, 0.75 and 0.80versusthe LLN were evaluated in 815 subjects (aged 20–44 yrs) with a diagnosis of asthma within the framework of the European Community Respiratory Health Survey.

In males, the 0.70 ratio showed 76.5% sensitivity and 100.0% specificity, the 0.75 ratio 100.0% sensitivity and 92.4% specificity, and the 0.80 ratio 100.0% sensitivity but 58.1% specificity. In females, the 0.70 ratio showed 57.3% sensitivity and 100.0% specificity, the 0.75 ratio 91.5% sensitivity and 95.9% specificity, and the 0.80 ratio 100.0% sensitivity but 72.9% specificity.

The fixed cut-off points cause a lot of misidentification of airflow obstruction in young adults, with overestimation with the 0.80 ratio and underestimation with the 0.70 ratio. In conclusion, the GINA guidelines should change their criteria for defining airflow obstruction.
Inflammatory pseudotumoural endotracheal mucormycosis with cartilage damage
Authors: Luo L-C. , Cheng D-Y. , Zhu H. , Shu X. , Chen W-B.
Published: August 2009

Mucormycosis is a rare opportunistic infection usually associated with immunosuppression, diabetes mellitus or haematological malignancy. Herein, we report an unusual case of mucormycosis in a 46-yr-old male patient with diabetes presenting with an endotracheal mass obstructing the trachea and cartilage damage. Histological examination of the bronchoscopy biopsy specimens revealed invasive mucormycosis. The patient was treated with intravenous amphotericin B followed by removal of the lesionviabronchoscopy.
Fatal dissection of the pulmonary artery in pulmonary arterial hypertension
Authors: Degano B. , Prevot G. , Têtu L. , Sitbon O. , Simonneau G. , Humbert M.
Published: August 2009

A 41-yr-old patient with chronic stable idiopathic pulmonary arterial hypertension (PAH) presented with sudden chest pain and unusual dyspnoea during physical exertion. The patient had been diagnosed with PAH at the age of 12 yrs and was in New York Heart Association functional class I/II. The patient was being treated with an anticoagulant regimen, low-dose diuretics and continuous intravenous epoprostenol therapy.

A computed tomography scan showed ancient massive thrombi in dilated central pulmonary arteries, which were not haemodynamically significant (perfusion lung scans did not demonstrate segmental or larger defects), and extensive dissection of the right pulmonary artery starting from the intermediate branch. Due to the extensiveness of the dissection, the patient was immediately considered for heart–lung transplantation, but died 72 h after the onset of symptoms. Permission forpost mortemexamination was denied.

Pulmonary artery dissection should be suspected in PAH patients presenting with chest pain and worsening dyspnoea. In the current case, the factors possibly associated with increased risk for dissection may include dilatation of the pulmonary artery, local inflammation favoured byin situthrombosis, and acute increase of pulmonary pressure secondary to physical exertion. Extensive pulmonary artery dissection is a life-threatening complication of PAH, and urgent heart/lung transplantation might be the treatment of choice in eligible patients. In addition, better identification of the risk factors for pulmonary artery dissection may help in considering transplantation for selected patients at risk.
Screening for pulmonary arterial hypertension in systemic sclerosis
Authors: Vachiéry J-L. , Coghlan G.
Published: August 2009

The onset and progression of pulmonary arterial hypertension (PAH) in patients with systemic sclerosis (SSc) can be particularly aggressive; however, effective treatments are available. Therefore, early identification of patients with suspected PAH, confirmation of diagnosis, and intervention is essential. PAH may be challenging to diagnose in its earliest stages, particularly in populations that have multiple causes of breathlessness, and, therefore, screening is required. The optimal screening tools and methodology are, as yet, unknown, and this is confounded by a lack of consensus over which patients to screen. Current practice favours annual screening of all SSc patients using Doppler echocardiography to detect elevated right heart pressures. This will typically identify most patients with the various forms of pulmonary hypertension found in SSc. The optimum thresholds for Doppler echocardiography are still subject to investigation, especially for patients with mild pulmonary hypertension, and this technique may, therefore, yield a significant number of false-positives and a currently unknown number of false-negatives. Confirmatory right heart catheterisation remains necessary in all suspected cases. Further research is needed to identify the optimal tools and the screening approach with greatest specificity and selectivity.
Chronic thromboembolic pulmonary hypertension as a cause of dyspnoea in an older patient with a complex history
Authors: Kähler C. M.
Published: August 2009

A full diagnostic work-up for patients with pulmonary hypertension (PH) is vital. Classification and diagnosis of the underlying cause is important to ensure optimal management, but may be complicated by overlapping signs and symptoms. This case study describes how a full work-up identified chronic thromboembolic PH (CTEPH) as the cause of dyspnoea in a 68-yr-old male with a history of pulmonary embolism and an original diagnosis of chronic obstructive pulmonary disease. Key indicators included decreased tricuspid annular plane systolic excursion, increased Tei index and elevated systolic pulmonary artery pressure. Multi-slice spiral chest computed tomography and pulmonary angiography showed severe chronic thromboembolic pulmonary disease, both centrally and distally. Diffusing capacity of the lung for carbon monoxide was reduced and blood gas analysis revealed a wide alveolar–arterial oxygen pressure difference, which is typical of CTEPH. The patient was eligible for pulmonary endarterectomy according to established criteria. Residual PH after surgery was successfully managed with bosentan.
Unusual presentation for a patent ductus arteriosus
Authors: Vizza C. D. , Badagliacca R. , Poscia R. , Gambardella C. , Pezzuto B. , Crescenzi E. , Papa S. , Fedele F.
Published: August 2009

A 63-yr-old black female, with a 1-yr history of hepatitis C and ascites was referred to an expert centre with suspicion of portopulmonary hypertension (PPHTN). Her poor condition made a rapid diagnosis imperative and precluded a normal diagnostic work-up.

Echocardiography confirmed severe pulmonary hypertension (PH). A hepatic scintigraphy and an abdominal echo-Doppler study excluded liver cirrhosis and portal hypertension. Cardiac magnetic resonance imaging showed marked dilation of the right ventricle with significant hypertrophy of the free wall, a finding that is uncommon in idiopathic pulmonary arterial hypertension or PPHTN. Right heart catheterisation demonstrated severe pre-capillary PH without response to acute vasodilator testing. Finally the patient underwent computed tomography angiography, which showed marked dilation of the pulmonary artery without thromboembolic disease and, unexpectedly, a partially calcified large patent ductus arteriosus.

The correct diagnosis of the underlying cause of pulmonary arterial hypertension is essential. Patients with underlying heart defects may have an atypical presentation and be referred to expert centres with an incorrect diagnosis. A full investigation is necessary; careful examination of right ventricular anatomy can provide clues about the aetiology of PH, and it is important to exclude intra- and extracardiac shunts during haemodynamic studies.
Pathway analysis for intracellular Porphyromonas gingivalis using a strain ATCC 33277 specific database
Authors: Hendrickson Erik L , Xia Qiangwei , Wang Tiansong , Lamont Richard J , Hackett Murray
Published: September 2009

Background

Porphyromonas gingivalis is a Gram-negative intracellular pathogen associated with periodontal disease. We have previously reported on whole-cell quantitative proteomic analyses to investigate the differential expression of virulence factors as the organism transitions from an extracellular to intracellular lifestyle. The original results with the invasive strain P. gingivalis ATCC 33277 were obtained using the genome sequence available at the time, strain W83 [GenBank: AE015924]. We present here a re-processed dataset using the recently published genome annotation specific for strain ATCC 33277 [GenBank: AP009380] and an analysis of differential abundance based on metabolic pathways rather than individual proteins.

Results

Qualitative detection was observed for 1266 proteins using the strain ATCC 33277 annotation for 18 hour internalized P. gingivalis within human gingival epithelial cells and controls exposed to gingival cell culture medium, an improvement of 7% over the W83 annotation. Internalized cells showed increased abundance of proteins in the energy pathway from asparagine/aspartate amino acids to ATP. The pathway producing one short chain fatty acid, propionate, showed increased abundance, while that of another, butyrate, trended towards decreased abundance. The translational machinery, including ribosomal proteins and tRNA synthetases, showed a significant increase in protein relative abundance, as did proteins responsible for transcription.

Conclusion

Use of the ATCC 33277 specific genome annotation resulted in improved proteome coverage with respect to the number of proteins observed both qualitatively in terms of protein identifications and quantitatively in terms of the number of calculated abundance ratios. Pathway analysis showed a significant increase in overall protein synthetic and transcriptional machinery in the absence of significant growth. These results suggest that the interior of host cells provides a more energy rich environment compared to the extracellular milieu. Shifts in the production of cytotoxic fatty acids by intracellular P. gingivalis may play a role in virulence. Moreover, despite extensive genomic re-arrangements between strains W83 and 33277, there is sufficient sequence similarity at the peptide level for proteomic abundance trends to be largely accurate when using the heterologous strain annotated genome as the reference for database searching.
Improved hospital-level risk adjustment for surveillance of healthcare-associated bloodstream infections: a retrospective cohort study
Authors: Tong ENC , Clements ACA , Haynes MA , Jones MA , Morton AP , Whitby M
Published: September 2009

Background

To allow direct comparison of bloodstream infection (BSI) rates between hospitals for performance measurement, observed rates need to be risk adjusted according to the types of patients cared for by the hospital. However, attribute data on all individual patients are often unavailable and hospital-level risk adjustment needs to be done using indirect indicator variables of patient case mix, such as hospital level. We aimed to identify medical services associated with high or low BSI rates, and to evaluate the services provided by the hospital as indicators that can be used for more objective hospital-level risk adjustment.

Methods

From February 2001-December 2007, 1719 monthly BSI counts were available from 18 hospitals in Queensland, Australia. BSI outcomes were stratified into four groups: overall BSI (OBSI), Staphylococcus aureus BSI (STAPH), intravascular device-related S. aureus BSI (IVD-STAPH) and methicillin-resistant S. aureus BSI (MRSA). Twelve services were considered as candidate risk-adjustment variables. For OBSI, STAPH and IVD-STAPH, we developed generalized estimating equation Poisson regression models that accounted for autocorrelation in longitudinal counts. Due to a lack of autocorrelation, a standard logistic regression model was specified for MRSA.

Results

Four risk services were identified for OBSI: AIDS (IRR 2.14, 95% CI 1.20 to 3.82), infectious diseases (IRR 2.72, 95% CI 1.97 to 3.76), oncology (IRR 1.60, 95% CI 1.29 to 1.98) and bone marrow transplants (IRR 1.52, 95% CI 1.14 to 2.03). Four protective services were also found. A similar but smaller group of risk and protective services were found for the other outcomes. Acceptable agreement between observed and fitted values was found for the OBSI and STAPH models but not for the IVD-STAPH and MRSA models. However, the IVD-STAPH and MRSA models successfully discriminated between hospitals with higher and lower BSI rates.

Conclusion

The high model goodness-of-fit and the higher frequency of OBSI and STAPH outcomes indicated that hospital-specific risk adjustment based on medical services provided would be useful for these outcomes in Queensland. The low frequency of IVD-STAPH and MRSA outcomes indicated that development of a hospital-level risk score was a more valid method of risk adjustment for these outcomes.
HIV-associated bladder cancer: a case series evaluating difficulties in diagnosis and management
Authors: Gaughan Elizabeth M , Dezube Bruce J , Bower Mark , Aboulafia David M , Bohac Gerry , Cooley Timothy P , Pantanowitz Liron
Published: September 2009

Background

Chronic human immunodeficiency virus (HIV) infection is associated with an increased incidence of Non-Acquired Immunodeficiency Syndrome (non-AIDS) defining cancers. To date, only a limited number of cases of bladder cancer have been linked with HIV infection. We sought to describe the clinical characteristics of HIV-associated bladder cancer.

Methods

A retrospective study was performed involving HIV-positive patients with bladder cancer, combining cases from multiple institutions with published case reports. Data regarding patient demographics, HIV status, clinical presentation, pathology, cancer treatment, and outcome were analyzed using descriptive statistics.

Results

Eleven patients were identified with a median age of 55 years (range, 33 - 67). The median CD4+ count at cancer diagnosis was 280 cells/mm3 (range, 106 - 572 cells/mm3). Six patients (55%) had a known risk factor for bladder cancer, and nine (82%) presented with hematuria. Ten patients had transitional cell carcinoma, and most had superficial disease at presentation. Treatment included mainly transurethral resection of bladder tumor followed by a combination of local and systemic therapies. One patient received intravesical bacillus Calmette-Guèrin (BCG) without complication. Several patients (55%) were alive following therapy, although many (64%) suffered from local relapse and metastatic disease.

Conclusion

Bladder cancer is part of the growing list of cancers that may be encountered in patients living longer with chronic HIV-infection. Our patients presented at a younger age and with only mild immunosuppression, however, they experienced an expected course for their bladder cancer. Hematuria in an HIV-infected patient warrants a complete evaluation.
Dichloroacetate alleviates development of collagen II-induced arthritis in female DBA/1 mice
Authors: Bian Li , Josefsson Elisabet , Jonsson Ing-Marie , Verdrengh Margareta , Ohlsson Claes , Bokarewa Maria , Tarkowski Andrej , Magnusson Mattias
Published: September 2009

Introduction

Dichloroacetate (DCA) has been in clinical use for the treatment of lactacidosis and inherited mitochondrial disorders. It has potent anti-tumor effects both in vivo and in vitro, facilitating apoptosis and inhibiting proliferation. The pro-apoptotic and anti-proliferative properties of DCA prompted us to investigate the effects of this compound in arthritis.

Methods

In the present study, we used DCA to treat murine collagen type II (CII)-induced arthritis (CIA), an experimental model of rheumatoid arthritis. DBA/1 mice were treated with DCA given in drinking water.

Results

Mice treated with DCA displayed much slower onset of CIA and significantly lower severity (P < 0.0001) and much lower frequency (36% in DCA group vs. 86% in control group) of arthritis. Also, cartilage and joint destruction was significantly decreased following DCA treatment (P = 0.005). Moreover, DCA prevented arthritis-induced cortical bone mineral loss. This clinical picture was also reflected by lower levels of anti-CII antibodies in DCA-treated versus control mice, indicating that DCA affected the humoral response. In contrast, DCA had no effect on T cell- or granulocyte-mediated responses. The beneficial effect of DCA was present in female DBA/1 mice only. This was due in part to the effect of estrogen, since ovariectomized mice did not benefit from DCA treatment to the same extent as sham-operated controls (day 30, 38.7% of ovarectomized mice had arthritis vs. only 3.4% in sham-operated group).

Conclusion

Our results indicate that DCA delays the onset and alleviates the progression of CIA in an estrogen-dependent manner.
Editorial: Proinflammatory cytokines in pneumonic tularemia: too much too late?
Authors: Cowley Siobhán C
Published: August 2009

Accumulating evidence indicates that the early initial immunosuppression of pneumonic tularemia is followed by a later overwhelming up–regulation of pro–inflammatory cytokines that is detrimental to the host.
Editorial: A recipe for inflammation
Authors: Bianchi Marco E
Published: August 2009

Many injectable protein preparations are contaminated with AGEs, post–translationally modified proteins that elicit inflammation and are therefore dangerous.
Early-onset dementia
Authors: Jefferies Kate , Agrawal Niruj
Published: August 2009

Dementia is is stereotypically associated with older people. However, in a significant minority it can affect people in their 40s and 50s, or even younger. Currently there is a lack of awareness, even among healthcare professionals, and there is a dearth of appropriate services for such patients. Despite the attention given to this condition by National Institute for Health and Clinical Excellence guidelines, provision of specialist early-onset dementia services in the UK remains patchy. Carers and patients often find themselves being passed ‘from pillar to post’ between psychiatry and neurology, and also between adult, old age and liaison psychiatry. The responsibility for identifying available and appropriate help is often left with carers. This leads to unnecessary delays, causes undue distress to patients and places an added burden on carers.
Risk assessment and management in obsessive–compulsive disorder
Authors: Veale David , Freeston Mark , Krebs Georgina , Heyman Isobel , Salkovskis Paul
Published: August 2009

Some people with obsessive–compulsive disorder (OCD) experience recurrent intrusive sexual, aggressive or death-related thoughts and as a result may be subjected to lengthy or inappropriate risk assessments. These apparent ‘primary’ risks can be dealt with relatively easily through a careful understanding of the disorder's phenomenology. However, there are other, less obvious ‘secondary’ risks, which require more careful consideration. This article discusses the differentiation of intrusive thoughts and urges in people with OCD from those experienced by sexual or violent offenders; assessing the risk of self-harm and suicide; discussing the nature of repugnant obsessions with a patient; assessing risk of harm and violence to the dependents and family living with someone with the disorder; and assessing the lack of insight and the use of the Mental Health Act. Issues specifically related to children and young people with OCD are also highlighted.
Depression in schizophrenia and early psychosis: implications for assessment and treatment
Authors: Upthegrove Rachel
Published: August 2009

Depression in schizophrenia has been a neglected field for some time, but much evidence exists as to the common occurrence of affective disturbance in so-called non-affective psychosis. Depression is related to poor outcome in terms of functional recovery, relapse rate and suicide, and there is increasing evidence that it also precedes the onset of first-episode psychosis for many individuals. This article reviews recent steps forward in the evidence base for depression in schizophrenia in terms of prevalence, importance, assessment and treatment implications, with the aim of providing useful information for practising psychiatrists.
Clinical judgement and individual patients: Invited Commentary on … In Defence of Professional Judgement
Authors: Thornton Tim
Published: August 2009

Although in agreement with their conclusions about the importance of clinical judgement, this commentary criticises the way that Downie & Macnaughton defend it in their article. I argue that their defence is both overly limited in its account of the role of judgement and that it employs unnecessarily contentious arguments. I outline the ineliminable role that judgement plays in determining which general diagnostic concepts fit individual patients given their individuality and specificity.
Dracula (1897), Bram Stoker
Authors: Subotsky Fiona
Published: August 2009

Bram Stoker (1847–1912) came from an Irish medical family whose influence is
not hard to detect in his most famous work, Dracula, which sadly did not
bring him the fame and fortune which his older brother William Thornley
achieved. The latter was not only President of the Irish College of Surgeons
and knighted, but held appointments at the two major Dublin asylums – the
Richmond Hospital and St Patrick's. He was even a member of the
Medico–Psychological Society for a while, and thus was well-placed to advise
on the activities and thought-processes of the doctors in Dracula.
Emotional side-effects of selective serotonin reuptake
inhibitors: qualitative study
Authors: Price Jonathan , Cole Victoria , Goodwin Guy M.
Published: August 2009

Background

Some people who take selective serotonin reuptake inhibitor (SSRI)
antidepressants report that their experience of emotions is ‘blunted’.
This phenomenon is poorly understood.

Aims

To understand patients' experiences of this phenomenon.

Method

Qualitative study, gathering data through individual interviews, a group
interview and validation interviews; and searching patient websites for
relevant posts.

Results

There was strong evidence that some people taking SSRIs experience
significant emotional symptoms that they strongly attribute to their
antidepressant. These emotional symptoms can be described within six key
themes. A seventh theme represents the impact of these side-effects on
everyday life, and an eighth represents participants' reasons for
attributing these symptoms to their antidepressant. Most participants
felt able to distinguish between emotional side-effects of
antidepressants and emotional symptoms of their depression or other
illness.

Conclusions

Emotional side-effects of SSRIs are a robust phenomenon, prominent in
some people's thoughts about their medication, having a demonstrable
impact on their functioning and playing a role in their decision-making
about antidepressant adherence.
Neuroanatomical correlates of different vulnerability states for
psychosis and their clinical outcomes
Authors: Koutsouleris Nikolaos , Schmitt Gisela J. E. , Gaser Christian , Bottlender Ronald , Scheuerecker Johanna , McGuire Philip , Burgermeister Bernhard , Born Christine , Reiser Maximilian , Möller Hans-Jürgen , Meisenzahl Eva M.
Published: August 2009

Background

Structural brain abnormalities have been described in individuals with an
at-risk mental state for psychosis. However, the neuroanatomical
underpinnings of the early and late at-risk mental state relative to
clinical outcome remain unclear.

Aims

To investigate grey matter volume abnormalities in participants in a
putatively early or late at-risk mental state relative to their
prospective clinical outcome.

Method

Voxel-based morphometry of magnetic resonance imaging data from 20 people
with a putatively early at-risk mental state (ARMS–E group) and 26 people
with a late at-risk mental state (ARMS–L group) as well as from 15
participants with at-risk mental states with subsequent disease
transition (ARMS–T group) and 18 participants without subsequent disease
transition (ARMS–NT group) were compared with 75 healthy volunteers.

Results

Compared with healthy controls, ARMS–L participants had grey matter
volume losses in frontotemporolimbic structures. Participants in the
ARMS–E group showed bilateral temporolimbic alterations and subtle
prefrontal abnormalities. Participants in the ARMS–T group had prefrontal
alterations relative to those in the ARMS–NT group and in the healthy
controls that overlapped with the findings in the ARMS–L group.

Conclusions

Brain alterations associated with the early at-risk mental state may
relate to an elevated susceptibility to psychosis, whereas alterations
underlying the late at-risk mental state may indicate a subsequent
transition to psychosis.
Social anxiety disorder in first-episode psychosis: incidence,
phenomenology and relationship with paranoia
Authors: Michail Maria , Birchwood Max
Published: August 2009

Background

Social anxiety disorder constitutes a significant problem for people with
psychosis. It is unclear whether this is a by-product of persecutory
thinking.

Aims

To compare the phenomenology of social anxiety disorder in first-episode
psychosis with that in a group without psychosis. The relationship
between social anxiety and psychosis symptoms was investigated.

Method

A sample of people with first-episode psychosis (FEP group) was compared
with a sample with social anxiety disorder without psychosis (SaD
group).

Results

Of the individuals in the FEP group (n = 80) 25% were diagnosed with an
ICD–10 social anxiety disorder (FEP/SaD group); a further 11.6% reported
severe difficulties in social encounters. The FEP/SaD and SaD groups
reported comparable levels of social anxiety, autonomic symptoms,
avoidance and depression. Social anxiety in psychosis was not related to
the positive symptoms of the Positive and Negative Syndrome Scale (PANSS)
including suspiciousness/persecution. However, a significantly greater
percentage of socially anxious v. non-socially anxious
individuals with psychosis expressed perceived threat from persecutors,
although this did not affect the severity of social anxiety within the
FEP/SaD group. The majority of those in the FEP/SaD group did not have
concurrent persecutory delusions.

Conclusions

Social anxiety is a significant comorbidity in first-episode psychosis.
It is not simply an epiphenomenon of psychotic symptoms and clinical
paranoia, and it has more than one causal pathway. For a subgroup of
socially anxious people with psychosis, anticipated harm is present and
the processes that underlie its relationship with social anxiety warrant
further investigation.
Selective drop-out in longitudinal studies and non-biased
prediction of behaviour disorders
Authors: Wolke Dieter , Waylen Andrea , Samara Muthanna , Steer Colin , Goodman Robert , Ford Tamsin , Lamberts Koen
Published: August 2009

Background

Participant drop-out occurs in all longitudinal studies, and if
systematic, may lead to selection biases and erroneous conclusions being
drawn from a study.

Aims

We investigated whether drop out in the Avon Longitudinal Study of
Parents And Children (ALSPAC) was systematic or random, and if
systematic, whether it had an impact on the prediction of disruptive
behaviour disorders.

Method

Teacher reports of disruptive behaviour among currently participating,
previously participating and never participating children aged 8 years in
the ALSPAC longitudinal study were collected. Data on family factors were
obtained in pregnancy. Simulations were conducted to explain the impact
of selective drop-out on the strength of prediction.

Results

Drop out from the ALSPAC cohort was systematic and children who dropped
out were more likely to suffer from disruptive behaviour disorder.
Systematic participant drop-out according to the family variables,
however, did not alter the association between family factors obtained in
pregnancy and disruptive behaviour disorder at 8 years of age.

Conclusions

Cohort studies are prone to selective drop-out and are likely to
underestimate the prevalence of psychiatric disorder. This empirical
study and the simulations confirm that the validity of regression models
is only marginally affected despite range restrictions after selective
drop-out.
Minor depression during adolescence and mental health outcomes
during adulthood
Authors: Johnson Jeffrey G. , Cohen Patricia , Kasen Stephanie
Published: August 2009

Data from a community-based prospective longitudinal study were used to
investigate the association of minor depressive disorder during adolescence
with adverse mental health outcomes during adulthood. Structured diagnostic
interviews were administered to a community-based sample of 755 individuals
during adolescence and adulthood. Results indicated that minor depressive
disorder during adolescence was associated with elevated risk for subsequent
psychiatric disorders during adulthood, including major depressive disorder,
⩾1 disruptive disorders and clinically relevant impairment after
corresponding and co-occurring disorders were controlled statistically.
Impact of persistent substance misuse on 1-year outcome in
first-episode psychosis
Authors: Turkington Aidan , Mulholland Ciaran C. , Rushe Teresa M. , Anderson Rick , McCaul Rosalind , Barrett Suzanne L. , Barr Ruth S. , Cooper Stephen J.
Published: August 2009

Background

Substance misuse is a common comorbid problem in people presenting with
first-episode psychosis and is associated with a poor short-term
outcome.

Aims

The aim of this study is to examine differences in baseline
characteristics and 1-year outcome between individuals with first-episode
psychosis who have never misused substances, those who stop misusing
substances after initial presentation and those who persistently misuse
substances over the 1-year assessment period.

Method

Patients were recruited to the Northern Ireland First Episode Psychosis
Study (n = 272). Clinical assessments were performed at baseline and at 1
year (n = 194) and data were collected from the case notes.

Results

Individuals with persistent substance misuse had more severe depression,
more positive symptoms, poorer functional outcome and greater rates of
relapse at 1 year than those who stopped and those who had never misused
substances. There were no differences in outcome between people who had
never misused substances and those who stopped misusing after
presentation.

These results support assertive intervention targeted at comorbid
substance misuse in individuals with first-episode psychosis.
Magnetic resonance imaging studies in bipolar disorder and
schizophrenia: meta-analysis
Authors: Arnone D. , Cavanagh J. , Gerber D. , Lawrie S. M. , Ebmeier K. P. , McIntosh A. M.
Published: August 2009

Background

Several magnetic resonance imaging (MRI) studies have identified
structural abnormalities in association with bipolar disorder. The
literature is, however, heterogeneous and there is remaining uncertainty
about which brain areas are pivotal to the pathogenesis of the
condition.

Aims

To identify, appraise and summarise volumetric MRI studies of brain
regions comparing bipolar disorder with an unrelated control group and
individuals with schizophrenia.

Method

A systematic review and random-effects meta-analysis was carried out to
identify key areas of structural abnormality in bipolar disorder and
whether the pattern of affected areas separated bipolar disorder from
schizophrenia. Significant heterogeneity was explored using
meta-regression.

Results

Participants with bipolar disorder are characterised by whole brain and
prefrontal lobe volume reductions, and also by increases in the volume of
the globus pallidus and lateral ventricles. In comparison with
schizophrenia, bipolar disorder is associated with smaller lateral
ventricular volume and enlarged amygdala volume. Heterogeneity was
widespread and could be partly explained by clinical variables and year
of publication, but generally not by differences in image
acquisition.

Conclusions

There appear to be robust changes in brain volume in bipolar disorder
compared with healthy volunteers, although most changes do not seem to be
diagnostically specific. Age and duration of illness appear to be key
issues in determining the magnitude of observed effect sizes.
Mental capacity and psychiatric in-patients: implications for the new mental health law in England and Wales
Authors: Owen Gareth S. , Szmukler George , Richardson Genevra , David Anthony S. , Hayward Peter , Rucker James , Harding Duncan , Hotopf Matthew
Published: August 2009

Background

In England and Wales mental health services need to take account of the Mental Capacity Act 2005 and the Mental Health Act 1983. The overlap between these two causes dilemmas for clinicians.

Aims

To describe the frequency and characteristics of patients who fall into two potentially anomalous groups: those who are not detained but lack mental capacity; and those who are detained but have mental capacity.

Method

Cross-sectional study of 200 patients admitted to psychiatric wards. We assessed mental capacity using a semi-structured interview, the MacArthur Competence Assessment Tool for Treatment (MacCAT–T).

Results

Of the in-patient sample, 24% were informal but lacked capacity: these patients felt more coerced and had greater levels of treatment refusal than informal participants with capacity. People detained under the Mental Health Act with capacity comprised a small group (6%) that was hard to characterise.

Conclusions

Our data suggest that psychiatrists in England and Wales need to take account of the Mental Capacity Act, and in particular best interests judgments and deprivation of liberty safeguards, more explicitly than is perhaps currently the case.
Depression under stress: ethical issues in genetic
testing
Authors: Newson Ainsley J.
Published: August 2009

Genetic testing for risk of depression requires a reconsideration of ethical
issues in genetics and how they manifest in psychiatric practice. A
precautionary approach is advocated in that there should be limits on the
use of the 5-HTT genetic test until its clinical utility and broader social
impact are better understood.
The psychiatric case register: noble past, challenging present,
but exciting future
Authors: Perera Gayan , Soremekun Mishael , Breen Gerome , Stewart Robert
Published: August 2009

Case registers have been fundamental to mental health research from the
early asylum studies onwards. Having declined in popularity over the past 20
years, they are likely to see a resurgence of interest with the advent of
electronic clinical records and the technological capacity to derive
anonymised databases from these.
Audit of handover documentation during patient transfers between learning disability psychiatry community teams
Authors: Miles Ömür Budanur
Published: August 2009

Aims and Method

The local experience of having to take over the care of patients newly moved to the Bristol area revealed the lack of clear information on their complex needs. Official guidelines do not exist, therefore a consensus list of expected handover information was produced. the records of two patients were analysed in each of the six teams that agreed to be audited. A standardised handover form was devised and introduced (Part 1). Part 2 of the audit was performed 18 months after the implementation of changes to practice.

Results

Part 1 revealed that diagnosis (11/12) and medications (12/12) were the best-documented items during handover correspondence. Follow-up duration (3/12), crisis plan (3/12), professionals involved (0/12) and risk assessment (3/12) if documented were done so only for patients with complex needs. Part 2 showed improved documentation of information (11/11 for the first two items and 10/11 for the remainder).

Clinical Implications

Absent or concealed information in patient notes may contribute to disruption to the continuity of care following patient transfers. the use of a succinct, structured and easily distinguishable handover form in patient records may facilitate communication between professionals.
Psychiatrists and electronic patient records: the South London and Maudsley experience
Authors: Mistry Himanshu , Sauer Justin
Published: August 2009

Aims and Method

To explore the experiences and attitudes of psychiatrists to a new electronic patient records system. A questionnaire was emailed to 115 psychiatrists across the South London & Maudsley National Health Service Foundation Trust.

Results

The total response rate was 66% (senior house officers 75%, specialist registrars 57%, consultants 56%). Technical problems, difficulty with patient confidentiality, administrative burden and impact on clinical work were identified as concerns. However, psychiatrists recognised the potential benefits and the majority did not wish to return to using paper records.

Clinical Implications

Electronic patient records are rapidly being integrated into the daily practice of psychiatrists. More administrative assistance and specific training should be provided to support clinicians who use this system.
Training and assessing independent nurse prescribers: a model for old age psychiatry
Authors: Cubbin Sally , Pearce Jane , Bullock Roger , McShane Rupert
Published: August 2009

Aims and Method

The brevity of training and assessment for independent nurse prescribers has caused some concern. We aimed to validate an Objective Structured Clinical Examination (OSCE) for potential nurse prescribers in dementia. Nurses' performance after 12 days of training for potential prescribers was compared with that of doctors of different grades.

Results

The performance of doctors, but not nurses, correlated with years of experience. Many nurses, especially those working in memory clinics, scored better than junior doctors.

Clinical Implications

This OSCE provides evidence of potential prescribers' competency for employers. This could make a significant contribution to maintaining high standards of patient safety with nurse prescribing. This may also be an appropriate addition to the assessment of specialty trainees as well as for revalidation.
A training experience to remember: working in Ghana
Authors: Poole Norman , Hughes Peter
Published: August 2009

Aims and Method

As part of a pilot project, one of the authors spent 3 months undertaking clinical work, teaching and research in a large psychiatric hospital in Accra, Ghana. the other acted as a UK-based mentor. Both report on the training value of the experience.

Results

It was possible to assimilate into the local healthcare system and effect some modest but sustainable changes. the experience broadened the trainee's understanding of psychiatry, cultural influences and healthcare systems, while also developing autonomy and resilience.

Clinical Implications

The post is now an option available to trainees on the rotation. Projects in training and service delivery to benefit the host institution have been identified.
Floods in 2007 and older adult services: lessons learnt
Authors: Hayes Joseph , Mason Julian , Brown Fay , Mather Rebecca
Published: August 2009

Aims and Method

To review the clinical and managerial impact of flooding on a community mental health team (CMHT) for older adults by prospectively recording all flooding related events met by the CMHT.

Results

Of 348 individuals known to the CMHT, 87 lived in flood affected areas. In nine patients symptoms deteriorated. There were two new referrals as a direct consequence of the flooding. Flood effects can be grouped into: new mental illness, management problems, CMHT workload, and secondary benefits.

Clinical Implications

The immediate and delayed problems caused by flooding to the elderly with mental illness and dementia include unmasking cognitive impairment and provoking exacerbations in depressive and anxiety disorders. Personal evacuation plans should be used when moving individuals with marked cognitive impairment to avoid difficulties with identification. Overcrowding of care homes used to temporarily accommodate additional residents can contribute to behavioural changes and psychological symptoms in those with pre-existing dementia.
On-site testing for drugs of misuse in the acute psychiatric ward
Authors: Ghali Sharif
Published: August 2009

Aims and Method

To explore why and how on-site urine drug testing is performed in in-patient settings. Data were collected by questionnaire in four acute psychiatric wards.

Results

The most commonly cited reasons for testing were suspected drug use and as a routine part of the admission procedure. On-site testing was typically favoured over laboratory methods owing to the rapid turnaround of results and ease of use. In 81% of cases the result of the tests had no effect on immediate management. the majority of staff had not received formal training in their use.

Clinical Implications

Clinical use of on-site drug tests does not reflect their established limitations. Guidance is required to direct staff in the use of this commonly used assessment tool.
On being the Trainee Editor of the Psychiatric Bulletin
Authors: George Sanju , Halder Neel
Published: August 2009

The Psychiatric Bulletin offers the post of a trainee editor on its Editorial Board, open to all trainees in psychiatry. In this paper we (the immediate past and current Trainee Editor) describe the roles and responsibilities, learning opportunities and our own experiences from our time as Trainee Editor of the Bulletin. We hope we will give readers some understanding of the immense learning potential and academic exposure that this post offers, and encourage trainees to consider whether it is of interest to them.
The role of the clinical professions in the regulation of healthcare in England: walking the tightrope
Authors: Lelliott Paul
Published: August 2009

The Royal Colleges and other professional bodies could use their clinical expertise, authority and influence with clinicians to improve the quality of regulation of healthcare services. At present, their contribution to regulation in England is ad hoc and informal. Better engagement could increase the impact that professional bodies have on patient care and create a new role for them as arbiters of quality in the organisation and delivery of care. the requirement for healthcare provider organisations to register with the Care Quality Commission from April 2010 and the National Health Service Next Stage Review have created an opportunity for closer collaboration. However, there are problems that must be overcome. These include the ownership of information about the quality of care and the uses to which this is put. It would be self-defeating if closer working with the regulator undermined the trust that clinicians have in quality improvement work led by the professional bodies.
Independent Review of E2100: A Phase III Trial of Bevacizumab Plus Paclitaxel Versus Paclitaxel in Women With Metastatic Breast Cancer
Authors: Gray Robert , Bhattacharya Suman , Bowden Christopher , Miller Kathy , Comis Robert L.
Published: September 2009

Purpose

E2100, an open-label, randomized, phase III trial conducted by the Eastern Cooperative Oncology Group (ECOG), demonstrated a significant improvement in progression-free survival (PFS) and overall response rate (ORR) with paclitaxel plus bevacizumab compared with paclitaxel alone as initial chemotherapy for patients with HER2-negative metastatic breast cancer.

Methods

An independent, blinded review of radiologic and clinical data was performed, assessing progression and response according to Response Evaluation Criteria in Solid Tumors. In addition, ECOG's investigator assessments were reanalyzed using the same methods applied to the independent review. The primary end point was PFS as assessed by an independent review facility (IRF).

Results

The addition of bevacizumab to paclitaxel resulted in a statistically significant improvement in PFS using both the IRF and investigator assessments. Hazard ratios for PFS (0.48, 95% CI, 0.385 to 0.607; P < .0001 for the IRF v 0.42, 95% CI, 0.34 to 0.52; P < .0001 for ECOG investigators) and the improvement in median PFS (11.3 v 5.8 months for the IRF v 11.4 v 5.8 months for ECOG investigators) were similar. Among patients with measurable disease at baseline, the IRF-assessed ORR was significantly higher in patients treated with paclitaxel and bevacizumab (48.9% v 22.2%; P < .0001).

Conclusion

The risk of progression was reduced by more than half and the ORR more than doubled with the addition of bevacizumab to weekly paclitaxel in both analyses, confirming a substantial and robust bevacizumab treatment effect. The consistency between the IRF and ECOG analyses validates the original data previously reported by ECOG in this open-label trial.
Frank P. Ramsey: A Cambridge Economist
Authors: Duarte Pedro Garcia
Published: September 2009

Frank Plumpton Ramsey was a Cambridge mathematician who produced profound work in logic, philosophy, mathematics and economics in the first-half of the twentieth century. He died at the age of twenty six, in 1930, and his contributions, despite being few in number, have been bearing fruits since then. Practitioners across those areas share the view that Ramsey was a genius ahead of his time. I explore in this article how Ramsey's image of a genius was created among eminent economists. I then discuss the main point of this essay: whether or not Ramsey may have had a research agenda in economics. His two major articles in this field seem to be unrelated. A common impression from these works and from Ramsey's interaction with other economists is that he was mostly a mathematician who was distracted by economists who from time to time sought his help with certain problems. Here I argue that Ramsey did have an economics research agenda, born out of his close relationship with Arthur Cecil Pigou. I support my thesis mostly with an archival evidence not explored thus far: some notes deposited at the University of Pittsburgh, here published for the first time.