bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Treatment of Nonmelancholic Depression: When Antidepressants Fail, Does Psychotherapy Work?
Authors: Parker Gordon , Graham Rebecca , Sheppard Elizabeth 
Published: July 2017

Objective: Treatment-resistant depression (TRD) is used as a descriptive or diagnostic term and has generated many management guidelines weighting antidepressant (AD) therapy, but which may be an inappropriate paradigm for the nonmelancholic disorders where psychotherapy may be a more salient modality. This study sought to evaluate the effectiveness of psychological therapy in patients whose nonmelancholic depressive condition had been resistant to at least 2 ADs. Method: Principal analyses compared 32 patients, diagnosed with a nonmelancholic depression who received 12 weeks of psychological therapy, with a small control group. Comparative analyses failed to find a distinct therapeutic effect, leading to an extension study pursuing candidate explanatory factors for this lack of response, including psychosocial factors. Results: While our sample showed a 41% response and 22% remission rate to psychotherapy, their improvement pattern was similar to the control group, thus arguing against any specific therapeutic benefit. Explanatory factors nominated by the treating psychologist weighted personality issues for 35% of the patients, distal stressors for 22%, and comorbid anxiety conditions for 18%. When sample members were compared with an age- and sex-matched sample of patients with nonmelancholic depression who improved distinctly during a similar 12-week period, rates of such putative personality, stress, and anxiety risk factors did not differ, arguing against the likelihood of these factors compromising improvement. Conclusions: Patients with nonmelancholic TRD also failed to demonstrate a clear response to a psychotherapeutic approach, while our pursuit of clinically explanatory variables was not supported empirically.
Caregiver Reports of Patient-Initiated Violence in Psychosis
Authors: Onwumere Juliana , Grice Sarah , Garety Philippa , Bebbington Paul , Dunn Graham , Freeman Daniel , Fowler David , Kuipers Elizabeth 
Published: July 2017

Objective: Aggressive behaviour in psychosis is not uncommon. Community provision for people with psychosis has left informal caregivers to take on a greater role in their care. However, few studies have explored links between patient-initiated violence in mental health caregiving relationships and caregiver functioning. Our study investigated caregiver reports of aggressive acts committed by their relative with psychosis and their links to caregiver appraisals of the caregiving relationship and caregiver outcomes. Method: Caregivers of patients with a recent relapse of psychosis, recruited to a psychological therapy trial, completed the audiotaped Camberwell Family Interview at baseline. This semi-structured interview includes questions on the quality of the relationship between caregiver and patient, and patient history of violence. Seventy-two transcripts of interviews were assessed for reports of patient-initiated violence. Results: One-half of the caregiver sample (52.9%) reported an incident of patient-initiated violence during their interview; 62.2% of these involved violence toward themselves, and 24.3% toward property. Reports of patient violence were associated with caregiver ratings of hostility expressed toward patients, lower self-esteem, and emotion-focused coping. People caring on their own were more likely to report incidents of patient violence. Younger patients, males, and inpatients were more frequently identified as having a history of this kind of violence. Conclusions: Our findings suggested that caregiver reports of patient-initiated violence in psychosis are not uncommon. Mental health staff need to be aware of the risks of such violence for caregivers of people with psychosis, and consider appropriate procedures for minimizing it.
Family Violence among Older Adult Patients Consulting in Primary Care Clinics: Results from the ESA (Enquête sur la santé des aînés) Services Study on Mental Health and Aging
Authors: Préville Michel , Mechakra-Tahiri Samia Djemaa , Vasiliadis Helen-Maria , Mathieu Véronique , Quesnel Louise , Gontijo-Guerra Samantha , Lamoureux-Lamarche Catherine , Berbiche Djamal 
Published: July 2017

Objective: To document the reliability and construct validity of the Family Violence Scale (FVS) in the older adult population aged 65 years and older. Method: Data came from a cross-sectional survey, the Enquête sur la santé des aînés et l'utilisation des services de santé (ESA Services Study), conducted in 2011–2013 using a probabilistic sample of older adults waiting for medical services in primary care clinics ( n = 1765). Family violence was defined as a latent variable, coming from a spouse and from children. Results: A model with 2 indicators of violence; that is, psychological and financial violence, and physical violence, adequately fitted the observed data. The reliability of the FVS was 0.95. According to our results, 16% of older adults reported experiencing some form of family violence in the past 12 months of their interview, and 3% reported a high level of family violence (FVS > 0.36). Our results showed that the victim's sex was not associated with the degree of violence (β = 0.02). However, the victim's age was associated with family violence (β = −0.12). Older adults, aged 75 years and older, reported less violence than those aged between 65 and 74 years. Conclusion: Our results lead us to conclude that family violence against older adults is common and warrants greater public health and political attention. General practitioners could play an active role in the detection of violence among older adults.
Antidepressant Use in Canada Has Stopped Increasing
Authors: Patten Scott B , Williams Jeanne V A , Lavorato Dina H , Fiest Kirsten M , Bulloch Andrew G M , Wang JianLi 
Published: July 2017

Objective: Large increases in the use of antidepressants (ADs) were reported in the past 2 decades in many countries, including Canada. Our objective was to determine whether this pattern of increasing use has continued, using data from a 2012 national mental health survey. Method: During the past 2 decades, a series of Canadian national health surveys have evaluated AD use in the household population. Some of these surveys have assessed past 2-day use whereas others have assessed self-reported past-month use. We applied meta-regression methods as a methodological strategy to address this heterogeneity and to examine long-term trends, incorporating 2012 data. Results: In keeping with prior reports, AD use rapidly increased in the 1990s and early 2000s. However, the 2012 data suggest that these increases have slowed or perhaps even stopped in recent years. A post hoc examination of longitudinal data from the National Population Health Survey reinforced the impression of a levelling off in the use of these medications. Conclusion: The frequency of AD use may now be stabilizing in the Canadian population. This emerging steady state may reflect a contemporary balance between the perceived need, perceived effectiveness, and acceptability of these medications in the general population.
AlloDerm® Lip Augmentation Techniques and Problem Avoidance
Authors: Kridel Russell W. H. 
Published: July 2017

Introduction: The aging process results in elongation of the white portion of the upper lip, an overall decrease in the bulk and volume of the red lip, and diminished projection of the cupid's bow. Various methods of augmentation of the lips have been attempted, including subnasal lip-lift, vermilion lip advancement, and augmentation procedures including injections of collagen and autologous fat, and placement of dermal and fascia grafts, Gore-Tex®, and Soft-form™. The new acellular dermal grafts, which were first used in 1993 for dermal replacement grafts in burn patients, are now being evaluated for use in lip augmentation. Materials and Methods: AlloDerm® (acellular dermal graft) was used for lip augmentation in 12 female patients. The graft was placed into the subcutaneous region (superficial to the orbicularis oris) through a small incision in the oral mucosa just superior to each commissure while the patient was anesthetized using a combination of local and regional anesthesia. Results: Eleven out of twelve patients were extremely pleased with the results. One patient had the graft removed because of a feeling of tightness, which restricted motion of the mouth. Conclusions: The acellular dermal graft provides bulk, persistence, and a natural-looking option for lip augmentation.
Hydrogel-Filled Mammary Prosthesis
Authors: Muller Guy-Henri 
Published: July 2017

Introduction: The silicone breast implant controversy and the moratorium on the use of silicone-gel-filled breast implants in the U.S., Canada, and France has led to a search for substitutes for silicone-gel implants that are safe, pliable, and still firm enough to hold its shape. Hydrogel is being evaluated as an alternative to silicone gel for filling breast implants. Materials and Methods: Eighteen hundred ninety hydrogel-filled breast implants were inserted into patients in France and Italy between 1992 and 1993. The postoperative results of these procedures were reviewed. Results: Twelve implant ruptures occurred at the time of insertion secondary to too small an incision and lack of prewarming of the implant. Two ruptures went unnoticed and were satisfactorily resolved with a revision of the first procedure. One capsule contracture occurred within one year. Visual results according to patients and surgeons were satisfactory. The palpable results are less favorable than silicone-gel implants, but better than saline-filled implants. Discussion: Hydrogel is biocompatible. The breakdown products of the implant filler, if they migrate outside the shell, should not be toxic. Because hydrogel is a biomaterial filler to which water is added to reach an equilibrium point, it mimics the consistency of living tissue. Conclusions: Hydrogel appears to be a favorable substitute for silicone gel.
Deep Cervical Fascia Plication in the Difficult Neck Rhytidectomy
Authors: Viera Hector M. 
Published: July 2017

Introduction: The purpose of the present article is to compare the long- and short-term results of two rhytidectomy techniques: the superficial musculoaponeurotic system (SMAS) plication and the plication of the deep cervical fascia (DCF). Materials and Methods: The areas of incision are injected with lidocaine 1% and epinephrine 1:200000. Klein's tumescent solution is then injected in the areas of skin dissection and liposuction. Submental and face liposuction are performed. Skin dissection is carried wide laterally to the anterior border of the SCM muscle, and, inferiorly, it extends near the sternal border if necessary. A 2–3-cm incision is made in the submental crease. Plication extends to the superior border of the thyroid cartilage. The malar fat pad is dissected and imbricated as described by Owsley. The SMAS is then dissected and imbricated extensively. Results: Plication of the DCF produces better long-term results than does SMAS plication and will benefit patients with severe sagging necks and sagging or bifid platysmata. Conclusions: Deep and wide plication of the platysma includes the DCF. The tenacious layer of fascia provides an anchorage which will maintain a tight neck over 8 years according to the author's experience.
Characterization of Sepsis and Sepsis-Associated Encephalopathy
Authors: Feng Qing , Ai Yu-Hang , Gong Hua , Wu Long , Ai Mei-Lin , Deng Song-Yun , Huang Li , Peng Qian-Yi , Zhang Li-Na 
Published: July 2017

Background: Sepsis and sepsis-associated encephalopathy (SAE) are common intensive care unit (ICU) diseases; the morbidity and mortality are high. The present study analyzed the sensitivity of different diagnostic criteria of sepsis 1.0 and 3.0, epidemiological characteristics of sepsis and SAE, and explored its risk factors for death, short-term, and long-term prognosis. Methods: The retrospective study included patients in ICU from January 2015 to June 2016. After excluding 58 patients, 175 were assigned to either an SAE or a non-SAE group (patients with sepsis but no encephalopathy). The sensitivity of the diagnostic criteria was compared between sepsis 1.0 and 3.0, respectively. Between-group differences in baseline data, Acute Physiology and Chronic Health Evaluation II score (APACHE II score), Sequential Organ Failure Assessment score (SOFA score), etiological data, biochemical indicators, and 28-day and 180-day mortality rates were analyzed. Survival outcomes and long-term prognosis were observed, and risk factors for death were analyzed through 180-day follow-up. Results: The sensitivity did not differ significantly between the diagnostic criteria of sepsis 1.0 and 3.0 ( P = .286). The 42.3% incidence of SAE presented a significantly high APACHE II and SOFA scores as well as 28-day mortality and 180-day mortality (all P < .001). The incidence of death was 37.1%. The multivariate stepwise regression analysis demonstrated that the risk of death in SAE group was significantly higher than the non-SAE group ( P < .001). Sepsis-associated encephalopathy is a risk factor for sepsis-related death (relative risk [RR] = 2.868; 95% confidence interval: 1.730-4.754; P < .001). Although males showed a significantly high rate of 28-day and 180-day mortality ( P = .035 and .045), it was not an independent risk factor for sepsis-related death ( P = .072). The long-term prognosis of patients with sepsis was poor with decreased quality of life. No significant difference was observed in prognosis between the SAE and non-SAE groups ( P > .05). Conclusion: Both diagnostic criteria cause misdiagnosis, and the sensitivity did not differ significantly. The incidence of SAE was high, and 28-day and 180-day mortality rates were significantly higher than those without SAE. Sepsis-associated encephalopathy is a risk factor for poor outcome. The overall long-term prognosis of patients with sepsis was poor, and the quality of life decreased.
Accelerometer-Determined Physical Activity and All-Cause Mortality in a National Prospective Cohort Study of Adults Post-Acute Stroke
Authors: Loprinzi Paul D. , Addoh Ovuokerie 
Published: July 2017

Purpose: No epidemiological study has examined the association of objectively measured physical activity with all-cause mortality among adults who have had a stroke, which was the purpose of this study. Design: Prospective. Setting: National Health and Nutrition Examination Survey 2003 to 2006. Participants: One hundred eighty-four patients with stroke. Measures: Physical activity assessed via accelerometry (ActiGraph 7164), with stroke assessed via self-report of physician diagnosis. Mortality was assessed via linkage with the National Death Index, with follow-up through 2011. Analysis: Cox proportional hazard model. Results: The median follow-up period was 71.96 months, with 13 241 person-months; 53 deaths occurred during this follow-up period. After adjustments, for every 60 min/d increase in total physical activity, adults who have had a stroke had a 28% (hazard ratio = 0.72; 95% confidence interval: 0.59-0.88) reduced risk of all-cause mortality. Conclusion: Physical activity among stroke survivors is inversely associated with all-cause mortality.
The association between ABO blood types and venous thromboembolism in individuals with a positive antiphospholipid profile is varied by sex
Authors: Shusterman M , Golub E , Mowrey W B , Broder A 
Published: July 2017

Objectives Although non-O blood type is an established risk factor for venous thromboembolism in the general population, the impact of ABO blood type (ABO) on venous thromboembolism risk in individuals with persistent antiphospholipid antibodies (aPL) has not been studied. We sought to investigate the relationship between ABO and venous thromboembolism in aPL-positive individuals. We also sought to explore potential interactions between ABO and sex or race to determine whether ABO contributes to race or sex differences with respect to the development of venous thromboembolism. Methods We identified all patients over 18 years old followed at a tertiary medical center between January 2000 and January 2015 with serological aPL criteria and ABO data. Episodes of venous thromboembolism were recorded. Logistic regression models were fitted to estimate odds ratios (ORs) of venous thromboembolism for non-O (A, B, or AB blood types) versus O blood type. Results There were 226 patients included in the final analysis, of whom 75 (33%) had reported venous thromboembolism. In the overall sample, there was a non-significant difference between venous thromboembolism in patients with non-O blood type compared to O blood type (OR 1.64, 95% confidence interval (CI) 0.94, 2.88; P = 0.08). Men with non-O blood type had a significantly higher risk of venous thromboembolism as compared to men with O-type blood (OR 4.94, 95% CI 1.37, 17.85; P = 0.02), but there was no significant association between ABO and venous thromboembolism among women (OR 0.96, 95% CI 0.50, 1.83; P = 0.52). Conclusions Non-O blood type may be an under-recognized risk factor for venous thromboembolism among men with persistent aPL antibodies, whereas the risk associated with non-O blood type seen in the general population may be attenuated in aPL-positive women.
Mannequin-Based Immersive Simulation Improves Resident Understanding of a Clinical Decision Rule
Authors: Harwayne-Gidansky Ilana , Bellis Jennifer M. , McLaren Son H. , Critelli Kristen , Clark Sunday , Chen Zhengming , Gerber Linda M. , Ching Kevin 
Published: July 2017

Objective.Simulation-based medical education may aid to standardize clinical performance measures, though there is little evidence for using an immersive, mannequin-based simulation for knowledge acquisition. We predicted that residents who had participated in an immersive simulation exercise illustrating the use of a clinical decision rule plus routine instructional methods (experimental group) would understand and implement this tool better than interns who participated in an immersive simulation focused on traumatic brain injury with intracranial hypertension plus routine instructional methods (control group 1). We further predicted that interns in the experimental group would understand and implement this tool as well as senior residents with more clinical experience (control group 2). Methods. This was a single center, prospective, simulation-based, randomized controlled trial. Pediatric interns were randomly assigned to clinically integrated teaching, plus a single, immersive simulation and structured debrief aimed at teaching this tool in minor head trauma (intervention), or clinically integrated teaching plus a related simulation on intracranial hypertension. Senior residents were used as an historical control arm and did not participate in a simulated encounter. Results. 20 interns (ten per group) participated in the study. Senior residents (n=40) served as historical comparisons. Interns in the intervention group scored similar to senior residents on a structured clinical observation score (median 64% vs. 57%), and better than interns in the placebo group (median 64% vs. 43%). Conclusions. In this study, a single immersive simulation improved resident learning and application of a clinical prediction rule when compared to standard resident education.
Nonweightbearing Radiographs in Patients With a Subtle Lisfranc Injury
Authors: Seo Dong-Kyo , Lee Ho-Seong , Lee Ki Won , Lee Suk Kyu , Kim Sang-Bum 
Published: July 2017

Background: A midfoot sprain can be easily missed because of minimal findings on initial radiographs, which are almost universally nonweightbearing. We investigated preoperative nonweightbearing plain radiographic images in patients who were found to have unstable subtle Lisfranc injuries. Methods: We retrospectively reviewed 51 patients who were operated on between February 2004 and March 2015. Abnormal preoperative radiographic findings and intraoperative instability were compared. The relationship was calculated with Fisher’s exact test. Results: Based on intraoperative findings, medial cuneiform (C1)–second metatarsal (M2) instability was observed in 50 cases (98%), which was the most common. Thirty-nine cases (76.4 %) had multiple joint (at least 2) instability. In the preoperative radiologic findings, C1-M2 diastasis was the most common abnormal finding, in 46 cases (90.1%). Specificity and positive predictive value were 1.0 in C1-M2 avulsion, diastasis, and C1–intermediate cuneiform (C2) diastasis. Abnormal findings of C1-C2, C1-M1, and C2-M2 showed a significant relationship with intraoperative instability ( P < .05). Conclusion: C1-M2 avulsion and diastasis and C1-C2 diastasis were definite preoperative predictors of instability. In unstable subtle Lisfranc injuries, 90% had at least a minor radiographic abnormality at the C1-M2 joint on nonweightbearing radiographs. However, caution should be exercised to identify instability without radiographic abnormality in the C1-M2 joint. Level of Evidence: Level IV, retrospective case series
Retrospective comparison of low molecular weight heparin vs. warfarin vs. oral Xa inhibitors for the prevention of recurrent venous thromboembolism in oncology patients: The Re-CLOT study
Authors: Alzghari Saeed K , Seago Susan E , Garza Jessica E , Hashimie Yasmeen F , Baty Kimberly A , Evans Martha F , Shaver Courtney , Herrington Jon D 
Published: July 2017

Background There is increasing evidence indicating oral factor Xa inhibitors can be used for secondary prevention of venous thromboembolism. Studies are needed to compare oral factor Xa inhibitors, low molecular weight heparins, and warfarin in the oncology population. The purpose of this study is to evaluate the recurrent venous thromboembolism incidence in oncology patients utilizing oral Xa inhibitors, low molecular weight heparins, or warfarin. Methods Using retrospectively collected data, we compared the recurrent venous thromboembolism incidence in oncology patients taking rivaroxaban/apixaban, enoxaparin, or warfarin with at least three months of follow-up. Patients were included if they had an active cancer, venous thromboembolism, and taking warfarin, enoxaparin, or rivaroxaban/apixaban. The primary endpoint was the first episode of recurrent venous thromboembolism at three months. Secondary endpoints included recurrent venous thromboembolism after six months, major bleeding, and mortality. Results Of 127 venous thromboembolism patients, 48 received rivaroxaban or apixaban, 23 received enoxaparin, and 56 received warfarin. The three most common cancer diagnoses were lung (21%), colorectal (14%), and breast (14%). There was no difference in venous thromboembolism recurrence at three months between the rivaroxaban/apixaban (0%), warfarin (3.6%), and the enoxaparin cohorts (4.4%) (p = 0.8319). Major bleeding at three months was only seen in one patient in the enoxaparin arm (4.2%). Mortality at three months was 0%, 3.6%, and 17.4% in the rivaroxaban/apixaban, warfarin, and enoxaparin cohorts, respectively. Conclusion The results of this retrospective study suggest that oral factor Xa inhibitors are potential options for cancer patients with venous thromboembolism. However, randomized, controlled trials are needed to confirm these results.