bluuebunny/crossref_metadata_2025_split huggingface dataset:
Community Treatment Orders: Profile of a Canadian Experience
Authors: O'Brien Ann-Marie A , Farrell Susan J 
Published: July 2017

Objective: This study reports the first published Canadian profile of a sample of psychiatric patients from the Royal Ottawa Hospital in Ottawa, Ontario, who were issued community treatment orders (CTOs). Method: We undertook a population study of sociodemographic and health care use patterns from January 2001 to September 2003, using a standardized information collection tool. Results: The issuance of CTOs was associated with a statistically significant reduction in the number and length of hospital admissions and increased use of supportive community-based services and supportive housing. Conclusion: CTOs are effective tools for allowing patients to live in the least restrictive setting possible while they receive diverse services. They also effectively reduce rates and lengths of readmission to hospital.
Sélection du Matériel Pour L'élaboration D'un Test de Stroop Émotionnel Adapté Aux Troubles Schizophréniques et Bipolaires
Authors: Besnier Nathalie , Kaladjian Arthur , Mazzola-Pomietto Pascale , Adida Marc , Fakra Eric , Jeanningros Régine , Azorin Jean-Michel 
Published: July 2017

Objectif: Le test de Stroop émotionnel évalue l'influence de la valence émotionnelle des stimuli sur les processus d'inhibition cognitive. Chez les sujets souffrant de troubles psychiatriques, l'interférence à ce test est augmentée lorsque la valence fait référence à leur psychopathologie spécifique. L'objectif de cette étude est d'élaborer une version du test de Stroop émotionnel adaptée à la schizophrénie paranoïde et au trouble bipolaire. Méthode: La valence émotionnelle et la fréquence d'emploi par les patients de 200 mots relatifs à la psychopathologie des troubles schizophréniques et bipolaires ont été soumises à l'évaluation de 25 cliniciens, puis à une analyse en composantes principales avec une classification ascendante hiérarchique. Résultats: Les mots se répartissent selon deux dimensions factorielles, l'émotionnalité et la tonalité, en quatre classes de valences différentes: mots dépressifs, paranoïdes, maniaques et neutres. La fréquence lexicale des mots retenus pour construire le test ne diffère pas. Conclusions: La validation statistique de la valence émotionnelle des mots permet la construction d'un test de Stroop émotionnel adapté à l'exploration des biais émotionnels dans la schizophrénie paranoïde et le trouble bipolaire.
Extended Evaluation of Serotonin Transporter Gene Functional Polymorphisms in Subjects with Post-Stroke Depression
Authors: Ramasubbu Rajamannar , Tobias Rose , Bech-Hansen N Torben 
Published: July 2017

Objective: As an extension of our previous observation, relating a serotonin transporter gene-linked promoter region (5-HTTLPR) diallelic functional polymorphism (short [S] and long [L] alleles) to the risk of post-stroke major depression (PSD), this study investigated the role of 2 other functional polymorphisms of the serotonin transporter gene (5-HTT) in the same sample of subjects with PSD. Method: In a clinical sample of 26 patients with PSD and 25 unrelated nondepressed stroke patients of Caucasian descent, we examined the frequencies of a functional single nucleotide variant (A/G) within the promoter region (rs25531) and located in L (16-repeat) and S (14-repeat) alleles of 5-HTTLPR, and a variable number tandem repeat (VNTR) polymorphism in intron 2. Results: There were significant intergroup differences in the allelic frequencies of 5-HTTLPR/rs25531 (SA, LA, and LG) ( P < 0.05) and in the combined frequencies of lower-expressing alleles (SA and LG) and higher-expressing alleles (LA) ( P < 0.025) between subjects with PSD and nondepressed stroke. However, the differences in the combined frequencies of lower-expressing (SA/SA, SA/LG, and LG/LG), intermediate-expressing (SA/LA and LA/LG), and higher-expressing (LA/LA) genotypes of 5-HTTLPR were not significant. Further, no significant intergroup differences were found in the allelic and genotypic frequencies of the intron 2 VNTR. Conclusions: These findings strengthen the support for an association between PSD and lower-expressing alleles of 5-HTTLPR.
Measuring Schizophrenia Remission in Clinical Practice
Authors: Alonso Jordi , Ciudad Antonio , Casado Alfonso , Gilaberte Inmaculada 
Published: July 2017

Objective: To evaluate reliability and validity of the short forms (SF) assessment of positive (SAPS) and negative (SANS) symptoms scales. Methods: In 235 Spanish schizophrenia outpatients, accuracy of the SF for measuring clinical remission (for at least 6 months) was assessed in comparison with the standard forms. Results: For the SF overall score, Cronbach's alpha was 0.78. Correlations with the standard form were 0.89, both cross-sectionally and longitudinally (0- to 12-month change scores). Using a cut-off score of 16, remission assessed by the SF had a sensitivity of 100% and a specificity of 72%. When using a cut-off score of 8, both sensitivity and specificity were 86%. Conclusions: The short forms of the SAPS and the SANS are reliable and have face validity for assessing remission of schizophrenia outpatients. They should be considered for use in routine clinical practice.
Changes in Mindfulness following Repetitive Transcranial Magnetic Stimulation for Mood Disorders
Authors: Leong KaWai , Chan Peter , Grabovac Andrea , Wilkins-Ho Michael , Perri Maria 
Published: July 2017

Objective: Mindfulness practices are associated with changes in different cortical regions, including the dorsolateral prefrontal cortices (DLPFCs). Our study sought to examine how an index course of repetitive transcranial magnetic stimulation (rTMS) over the DLPFC improved components of mindfulness as assessed by Baer's Five Facet Mindfulness Questionnaire (FFMQ) and the Experience Questionnaire (EQ). Method: Our preliminary study is a retrospective chart review of 32 patients who had undergone an index course of rTMS for major depressive episode between 2009 and 2012. The following information was collected prior to rTMS: patient demographics, diagnosis, and age of onset of primary diagnosis. The following information was collected prior to and after rTMS: 21-item Hamilton Rating Scale for Depression (HRSD) scores, Patient-Health Questionnaire (PHQ-9) scores, Generalized Anxiety Disorder 7-item (GAD-7) scale scores, FFMQ scores, and EQ scores. Results: Following rTMS, results showed statistically significant decreases in HRSD, PHQ-9, and GAD-7 scores. There was significant improvement in the nonreactivity to inner experience subscale of the BFFMQ and in the decentring subscale of the EQ. Subgroup analysis between patients who did not improve on the HRSD by 50% or more following rTMS and those who did revealed no baseline difference in mindfulness. There was significant improvement in the decentring subscale of the EQ in both subgroups. Conclusions: Our study provides preliminary data that rTMS may be associated with improvement in some components of mindfulness, independently of changes in depression.
Les interventions basées sur les résultats probants en réadaptation psychiatrique: Auxquelles accorder la priorité et pourquoi?
Authors: Lecomte Tania , Corbière Marc , Leclerc Claude 
Published: July 2017

Objectif: Cette revue de littérature critique décrit les interventions psychosociales en réadaptation psychiatrique reconnues pour leurs résultats probants. Méthode: Une description brève des méta-analyses et (ou) des revues de littérature les plus récentes est présentée pour chaque intervention ciblée, ainsi qu'une description des interventions, de leur pertinence en réadaptation psychiatrique et de leurs limites. Résultats: Les interventions retenues sont: les interventions familiales, la thérapie cognitive-comportementale pour la psychose, l'entraînement aux habiletés sociales, la thérapie de remédiation cognitive, les programmes intégrés pour toxicomanie et troubles mentaux, et les programmes de soutien à l'emploi. Conclusions: Les interventions en réadaptation psychiatrique retenues dans ce article sont non seulement basées sur des résultats probants, mais offrent aussi des outils cliniques pour le rétablissement de la personne souffrant d'un trouble mental.
Informed Consent Is the Essence of Capacity Assessment
Authors: Spike Jeffrey P. 
Published: July 2017

Informed consent is the single most important concept for understanding decision-making capacity. There is a steady pull in the clinical world to transform capacity into a technical concept that can be tested objectively, usually by calling for a psychiatric consult. This is a classic example of medicalization. In this article I argue that is a mistake, not just unnecessary but wrong, and explain how to normalize capacity assessment.Returning the locus of capacity assessment to the attending, the primary care doctor, and even to ethics consultation in today's environment will require a substantial effort to undo a strong but illusory impression of capacity assessment. Hospital attorneys as well as clinical ethicists with a sophisticated understanding of health law can be in the vanguard of this reorientation.
Morbidity and mortality meetings at Australian major trauma centres: A proof of concept study
Authors: Bear H , Mok MT , Farrow N , Curtis K , Mitra B , Fitzgerald M , Gruen RL 
Published: July 2017

Background Morbidity and mortality meetings are held at all Australian major trauma centres and provide a forum to identify problems and improve practices. Meetings should focus on addressing factors in the system to prevent similar errors occurring, rather than individual culpability. This paper describes current meeting practices and assesses the use of a systems approach. Methods This proof of concept study used a convenience sample of four Australian major trauma centres. Trauma leaders at each centre were surveyed regarding morbidity and mortality meeting practices. The use of a systems approach was measured by assessing practices against the London Protocol for Systems Analysis of Clinical Incidents. Meeting participants were also surveyed regarding perceptions of the objectives and effectiveness of meetings. Results This study found variable utilisation of a systems approach. Cases are not routinely analysed for contributing system factors and effective processes are not always used to correct problems that are identified. Meeting practices also vary between centres in terms of frequency, case selection criteria and use of audit filters. Participants generally view quality improvement as the most important objective of meetings. Conclusion Morbidity and mortality meeting practices vary between Australian major trauma centres and a systems approach has not been fully adopted.
Outcomes of sympathectomy and vascular bypass for digital ischaemia in connective tissue disorders
Authors: Shammas R. L. , Hwang B. H. , Levin L. S. , Richard M. J. , Ruch D. S. , Mithani S. K. 
Published: July 2017

All patients (36 hands) with connective tissue disorders who underwent periarterial sympathectomy of the hand alone or in conjunction with vascular bypass at our institution between 1995–2013 were reviewed. The durable resolution of ulcers was significantly higher in patients treated by periarterial sympathectomy and bypass than in patients treated by periarterial sympathectomy alone. Although there were more digital amputations in patients treated by periarterial sympathectomy alone, the difference was not statistically significant. Vascular bypass in conjunction with sympathectomy may be better than sympathectomy alone in patients with digital ischaemia related to connective tissue disorders. Level of evidence: IV
Management of myocardial infarction in the elderly. Insights from Spanish Minimum Basic Data Set
Authors: Ariza-Solé Albert , Alegre Oriol , Elola Francisco J , Fernández Cristina , Formiga Francesc , Martínez-Sellés Manuel , Bernal José L , Segura José V , Iñíguez Andrés , Bertomeu Vicente , Salazar-Mendiguchía Joel , Sánchez Salado José C , Lorente Victòria , Cequier Angel 
Published: July 2017

Background: We aimed to assess the impact of implementation of reperfusion networks, the type of hospital and specialty of the treating physician on the management and outcomes of ST segment elevation myocardial infarction in patients aged ⩾75 years. Methods: We analysed data from the Minimum Basic Data Set of the Spanish public health system, assessing hospital discharges between 2004 and 2013. Discharges were distributed in three groups depending on the clinical management: percutaneous coronary intervention, thrombolysis or no reperfusion. Primary outcome measure was all cause in-hospital mortality. For risk adjustment, patient comorbidities were identified for each index hospitalization. Results: We identified 299,929 discharges, of whom 107,890 (36%) were in-patients aged ⩾75 years. Older patients had higher prevalence of comorbidities, were less often treated in high complexity hospitals and were less frequently managed by cardiologists ( p<0.001). Both percutaneous coronary intervention and fibrinolysis were less often performed in elderly patients ( p<0.001). A progressive increase in the rate of percutaneous coronary intervention was observed in the elderly across the study period (from 17% in 2004 to 45% in 2013, p<0.001), with a progressive reduction of crude mortality (from 23% in 2004 to 19% in 2013, p<0.001). Adjusted analysis showed an association between being treated in high complexity hospitals, being treated by cardiologists and lower in-hospital mortality ( p <0.001). Conclusions: Elderly patients with ST segment elevation myocardial infarction are less often managed in high complexity hospitals and less often treated by cardiologists. Both factors are associated with higher in-hospital mortality.
Bilateral diaphragmatic paresis following pediatric liver transplantation
Authors: Olmscheid Jillian , Molero Helena , Gershan William , Demirel Nadir 
Published: July 2017

Background: Although diaphragm paresis or paralysis is fairly common following cardiac procedures; it is a less common complication following liver transplantation. Unilateral diaphragm paresis, usually right sided, has been described following liver transplantation in adults and has been rarely described in children. Purpose: Diaphragmatic injury following LT is often unrecognized and is typically unilateral, involving the right hemidiaphragm. Bilateral diaphragm dysfunction following liver transplantation in children is a rare complication. Methods: This is a case report of bilateral diaphragm paresis in a young child following a repeat liver transplantation. Conclusion: Bilateral diaphragm paresis following liver transplantation in children is rare and spontaneous resolution is possible. A conservative approach with noninvasive ventilation as a first line treatment to allow the diaphragm to regain function should be considered.
Dural Tears in Adult Deformity Surgery: Incidence, Risk Factors, and Outcomes
Authors: Iyer Sravisht , Klineberg Eric O. , Zebala Lukas P. , Kelly Michael P. , Hart Robert A. , Gupta Munish C. , Hamilton D. Kojo , Mundis Gregory M. , Sciubba Daniel , Ames Christopher P. , Smith Justin S. , Lafage Virginie , Burton Douglas , Kim Han Jo ,   for the International Spine Study Group (ISSG)
Published: July 2017

Study Design: Retrospective cohort study. Objectives: Describe the rate of dural tears (DTs) in adult spinal deformity (ASD) surgery. Describe the risk factors for DT and the impact of this complication on clinical outcomes. Methods: Patients with ASD undergoing surgery between 2008 and 2014 were separated into DT and non-DT cohorts; demographics, operative details, radiographic, and clinical outcomes were compared. Statistical analysis included t tests or χ2 tests as appropriate and a multivariate analysis. Results: A total of 564 patients were identified. The rate of DT was 10.8% (n = 61). Patients with DT were older (61.1 vs 56.5 years, P = .005) and were more likely to have had prior spine surgery (odds ratio [OR] = 2.0, 95% confidence interval [CI] = 1.2-3.3, P = .007). DT patients had higher pelvic tilt, lower lumbar lordosis, and greater pelvic-incidence lumbar lordosis mismatch than non-DT patients ( P < .05). DT patients had longer operative times (424 vs 375 minutes, P = .008), were more likely to undergo interbody fusions (OR = 2.0, 95% CI = 1.1-3.6, P = .021), osteotomies (OR = 2.2, 95% CI = 1.1-4.0, P = .012), and decompressions (OR = 2.3, 95% CI = 1.3-4.3, P = .003). In our multivariate analysis, only decompressions were associated with an increased risk of DT (OR = 3.2, 95% CI = 1.4-7.6, P = .006). There were no significant differences in patient outcomes at 2 years. Conclusions: The rate of DT was 10.8% in an ASD cohort. This is similar to rates of DT reported following surgery for degenerative pathology. A history of prior spine surgery, decompression, interbody fusion, and osteotomies are all associated with an increased risk of DT, but decompression is the only independent risk factor for DT.
Sepsis in the burn patient: a different problem than sepsis in the general population
Authors: Greenhalgh David G. 
Published: July 2017

Abstract
Sepsis has recently been defined as “life-threatening organ dysfunction caused by a dysregulated host response to infection”. A great amount of effort has been made to develop early treatments for sepsis through the Surviving Sepsis Campaign. There are similar but slightly different recommendations for the treatment of sepsis in the pediatric population. These international efforts have led to earlier diagnosis and treatments for sepsis that have led to improvements in survival. Sepsis is also the leading cause of death in the burn patient but most clinical sepsis studies have excluded burns. The reason for the exclusion is that the sepsis found in burn patients is different than that of the general population. The early treatment strategies, such as those directed by the Surviving Sepsis Campaign, focus on patients presenting to hospitals with recent signs of infection. Burn patients lose their primary barrier to infection, the skin, and thus the risk of infection persists as long as that barrier is absent. Efforts have been made to define sepsis, septic shock and infection in the burn population but there is constant need for revisions. One focus of this review is to discuss the differences in burn sepsis versus sepsis of the general population. Children often have profound responses to sepsis but can also make remarkable recoveries. This review will also explore problems specific to pediatric burns. The treatment of burns requires a continuous vigilance to watch for the subtle early signs of sepsis and then expeditious initiation of aggressive therapy. Strategies covering optimal management of pediatric burn sepsis will also be summarized.
Comparative Toxicity and Effectiveness of Trastuzumab-Based Chemotherapy Regimens in Older Women With Early-Stage Breast Cancer
Authors: Reeder-Hayes Katherine E. , Meyer Anne Marie , Hinton Sharon Peacock , Meng Ke , Carey Lisa A. , Dusetzina Stacie B. 
Published: July 2017

Purpose The combination of chemotherapy and trastuzumab is the standard of care for adjuvant treatment of human epidermal growth factor receptor 2–positive breast cancer. Two regimens have been widely adopted in the United States: doxorubicin, cyclophosphamide, paclitaxel, and trastuzumab (ACTH) and docetaxel, carboplatin, and trastuzumab (TCH). No head-to-head comparison of these regimens has been conducted in a clinical trial, and existing trial data have limited generalizability to older patients. Methods We used SEER-Medicare data from 2005 to 2013 to compare outcomes of ACTH versus TCH among patients age older than 65 years. Propensity score matching was used to balance cohort characteristics between treatment arms. Outcomes included toxicity-related hospitalization, survival, and trastuzumab completion. Data from 1,077 patients receiving ACTH or TCH were analyzed, and the propensity-matched subsample included 416 women. Results There was a significant shift toward TCH over time, with 88% of patients receiving ACTH in 2005 compared with 15% by 2011. Among propensity score–matched patients, we found no difference between regimens in health care use overall or for chemotherapy-related adverse events (ACTH, 34% v TCH, 36.5%; P = .46). Patients receiving TCH were significantly more likely to complete trastuzumab (89% v 77%; P = .001). There was no difference in 5-year breast cancer–specific survival (ACTH, 92% v TCH, 96%; hazard ratio, 2.08; 95% CI, 0.90 to 4.82) or overall survival. Conclusion Among a matched sample of older patients, ACTH compared with TCH was not associated with a higher rate of serious adverse events or hospitalizations, but it was associated with less completion of adjuvant trastuzumab. We did not detect a difference in 5-year survival outcomes for ACTH compared with TCH. In the context of limited evidence in older patients, selection between these two regimens on the basis of concerns about differential toxicity or efficacy may not be appropriate.
Association of Physician Orders for Life-Sustaining Treatment Form Use With End-of-Life Care Quality Metrics in Patients With Cancer
Authors: Pedraza Sandra L. , Culp Stacey , Knestrick Mark , Falkenstine Evan , Moss Alvin H. 
Published: July 2017

Purpose: Many patients with advanced cancer receive aggressive treatment near the end of life. The Physician Orders for Life-Sustaining Treatment (POLST) form is an innovation that converts patient preferences into medical orders. We compared the end-of-life care of patients with advanced cancer who had completed POLST forms with that of patients who had advance directives (ADs). Methods: We studied 2,159 West Virginians with ADs and/or POLST forms in the West Virginia e-Directive Registry who died as a result of cancer between January 2011 and February 2016. Data from the Vital Registration Office (date, site, and cause of death) were merged with those from the registry (form type, completion date, and hospice admission). The primary outcome variables were out-of-hospital death (OHD) and hospice admission. Results: The percentage of patients with OHD was 85.7% for patients with POLST forms compared with 72.0% for those with ADs ( P < .001). The odds of OHD for patients with POLST forms were 2.33 times those of patients with ADs. The percentage of patients admitted to hospice was 49.9% for those with POLST forms compared with 27.0% for those with ADs ( P < .001). The odds of being admitted to hospice for patients with POLST forms were 2.69 times those of patients with ADs. Conclusion: Advance care planning with completion of POLST forms compared with ADs in patients with advanced cancer was associated with two quality end-of-life care metrics: OHD and hospice admission. Our study suggests that goals-of-care discussions including POLST form completion may improve end-of-life care for patients with advanced cancer.