bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving quality of life for people with dementia in care homes: making psychosocial interventions work
Authors: Lawrence Vanessa , Fossey Jane , Ballard Clive , Moniz-Cook Esme , Murray Joanna 
Published: November 2012

BackgroundPsychosocial interventions can improve behaviour and mood in people with dementia, but it is unclear how to maximise their effectiveness or acceptability in residential settings.AimsTo understand what underlies the successful implementation of psychosocial interventions in care homes.MethodSystematic review and meta-synthesis of qualitative research.ResultsThe synthesis of 39 qualitative papers revealed that beneficial psychosocial interventions met the needs of people with dementia to connect with others, make a meaningful contribution and reminisce. Successful implementation rested on the active engagement of staff and family and the continuing provision of tailored interventions and support. This necessitated staff time, and raised issues around priorities and risk, but ultimately helped redefine staff attitudes towards residents and the caregiving role.ConclusionsThe findings from the meta-synthesis can help to inform the development and evaluation of psychosocial interventions in care homes and support their widespread implementation in clinical settings.
Depression and cardiovascular disease: the end of simple models
Authors: de Jonge Peter , Roest Annelieke M. 
Published: November 2012

SummaryIn this editorial, we propose that the association between depression and cardiovascular disease may be conceptualised as a continuous, bidirectional process that originates in youth. The paper by Åberg and colleagues in this issue adds to this literature showing that low cardiovascular fitness at adolescence increases the risk of future depression.
Advice on driving while under the care of a crisis resolution team: findings from two audits
Authors: Curwen Joanna , Jebreel Amy 
Published: November 2012

Aims and methodTo examine the documentation regarding patients driving while under the care of a crisis resolution team and whether advice is being given by all members of the team. An audit was carried out looking at the case records of patients and information was collated about whether they had been asked if they were driving and whether any advice had been given. Following the audit there was a team presentation and guidelines distributed. The audit was repeated 6 months later.ResultsThe first cycle of the audit included 58 patients. There was documentation about driving for two patients and appropriate advice given for one. The second cycle included 53 patients. There was documentation about two patients and advice given for one.Clinical implicationsPatients are not being asked whether they drive and advice is not routinely being given despite clear guidelines. Further research is needed to look at interventions at a local level that could improve this.
Trainees' views of portfolios in psychiatry
Authors: Halder Neel , Subramanian Ganesh , Longson Damien 
Published: November 2012

Aims and methodPortfolios are now used extensively within the field of psychiatry and our aim was to obtain trainees' feedback on their value. We used a questionnaire to evaluated trainees' priorities, what educational tools they found most helpful, how much time trainees spent on preparing their portfolios and the best and worst aspects of the portfolios.ResultsThe survey was completed by 207 out of 228 trainees (90.8%). The majority (58.4%) rated ‘Passing the ARCP [Annual Review of Competence Progression]’ as their top priority. More trainees found benefit from the feedback of workplace-based assessments (33.3%) than the ratings given (24.1%). Time spent on portfolios on a weekly basis ranged from 5 min to 12 h (the most common answer was 1–2 h). A total of 50.7% felt they did not have enough time to spend on their portfolios. Many found it encouraged reflective practice, but wanted more training for both trainees and trainers on how to use them properly.Clinical implicationsThe expansion of portfolios within the changing National Health Service requires careful planning and training, and perhaps some allocated time to complete them, so that trainees can derive the maximum benefits from the portfolio's intended purpose.
Enhancing the effectiveness of community drug and alcohol teams working with opioid-dependent pregnant women: results of an audit
Authors: Sairam Mani , Magon Rakesh , Kouimtsidis Christos 
Published: November 2012

Aims and methodTo evaluate the quality of services offered by community drug and alcohol teams (CDATs) to pregnant women in substitution treatment. A full audit of the practice across all local CDATs against national standards was undertaken in 2008 and 2010.ResultsQuality of services improved and met three standards in 100% and the fourth standard in 96% of cases. There was good implementation of the recommendations arising out of the action plan of the first cycle, which resulted in significant improvements in interagency liaison and risk-benefit analysis documentation within the CDATs.Clinical implicationsManagement of pregnant women in substitution treatment can be improved by adhering to a multipronged approach as identified by this audit.
Genetic testing of adults with intellectual disability
Authors: de Villiers Jana , Porteous Mary 
Published: November 2012

MethodPatients known to learning disability services in two health boards in southeast Scotland were cross-matched with the patients tested at the Western General Hospital in Edinburgh. Those with a positive genetic diagnosis were identified. Semi-structured interviews were conducted with senior learning disability psychiatrists and clinical genetics consultants.ResultsOf the 3323 patients with intellectual disability across both health boards, 41% have had genetic tests and 6% have an identified genetic abnormality as the cause for their intellectual disability. Of the 1349 patients who have been tested, a genetic abnormality was found in 14%. Psychiatrists named several benefits to genetic testing, but they also highlighted a number of non-medical reasons for not testing adults with intellectual disability.Clinical implicationsIdentifying genetic aetiology in intellectual disability has a number of benefits. Our study would indicate that genetic diagnoses are being missed due to a lack of genetic testing in this patient group. Adult learning disability services need to consider increasing genetic testing.
Catatonia in a woman who is profoundly deaf-mute: case report
Authors: Akintomide Gbolagade Sunmaila , Porter Stuart Williams , Pierce Anita 
Published: November 2012

SummaryCatatonia is a common but underrecognised complication of bipolar disorder, with a quarter of in-patients with bipolar disorder developing catatonia. Almost 9 million people in the UK are deaf or have a significant hearing problem and British Sign Language is the preferred language of 50 000–70 000 people within the UK. Between 1 and 2% of these individuals (i.e. the same as in the rest of the population) will experience bipolar disorder in their lifetime and therefore the accurate diagnosis of catatonia is important. We report a case of catatonia presenting with dysphagia in a woman who is profoundly deaf–mute and who has bipolar disorder. This report highlights some modifications of presentation and difficulties of accurate diagnosis and management of catatonia in this patient. To the best of our knowledge, this is the first case report of catatonia in someone who is profoundly deaf–mute.
Functional results and complications following conversion of hip fusion to total hip replacement
Authors: Aderinto J. , Lulu O. B. , Backstein D. J. , Safir O. , Gross A. E. 
Published: November 2012

Eighteen hip fusions were converted to total hip replacements. A constrained acetabular liner was used in three hips. Mean follow up was five years (two to 15). Two (11%) hips failed, requiring revision surgery and two patients (11%) had injury to the peroneal nerve. Heterotopic ossification developed in seven (39%) hips, in one case resulting in joint ankylosis. No hips dislocated.Conversion of hip fusion to hip replacement carries an increased risk of heterotopic ossification and neurological injury. We advise prophylaxis against heterotropic ossification. When there is concern about hip stability we suggest that the use of a constrained acetabular liner is considered. Despite the potential for complications, this procedure had a high success rate and was effective in restoring hip function.
Cementless fixation in total knee arthroplasty
Authors: Ranawat C. S. , Meftah M. , Windsor E. N. , Ranawat A. S. 
Published: November 2012

There has been a recent increase in interest for non-cemented fixation in total knee arthroplasty (TKA), however the superiority of cement fixation is an ongoing debate.Whereas the results based on Level III and IV evidence show similar survivorship rates between the two types of fixation, Level I and II evidence strongly support cemented fixation. United Kingdom, Australia, Sweden, and New Zealand registry data show lower failure rates and greater usage of cemented than non-cemented fixation. Case series studies have also indicated greater functional outcomes and lower revision rates among cemented TKAs. Non-cemented fixation involves more patellofemoral complications, including increased susceptibility to wear due to a thinner polyethylene bearing on the cementless metal-backed component. The combination of results from registry data, prospective randomised studies, and meta-analyses support the current superiority of cemented fixation in TKAs.
A prospective, multi-center, randomised trial to evaluate the efficacy of a cryopneumatic device on total knee arthroplasty recovery
Authors: Su E. P. , Perna M. , Boettner F. , Mayman D. J. , Gerlinger T. , Barsoum W. , Randolph J. , Lee G. 
Published: November 2012

Pain, swelling and inflammation are expected during the recovery from total knee arthroplasty (TKA) surgery. The severity of these factors and how a patient copes with them may determine the ultimate outcome of a TKA. Cryotherapy and compression are frequently used modalities to mitigate these commonly experienced sequelae. However, their effect on range of motion, functional testing, and narcotic consumption has not been well-studied. A prospective, multi-center, randomised trial was conducted to evaluate the effect of a cryopneumatic device on post-operative TKA recovery. Patients were randomised to treatment with a cryopneumatic device or ice with static compression. A total of 280 patients were enrolled at 11 international sites. Both treatments were initiated within three hours post-operation and used at least four times per day for two weeks. The cryopneumatic device was titrated for cooling and pressure by the patient to their comfort level. Patients were evaluated by physical therapists blinded to the treatment arm. Range of motion (ROM), knee girth, six minute walk test (6MWT) and timed up and go test (TUG) were measured pre-operatively, two- and six-weeks post-operatively. A visual analog pain score and narcotic consumption was also measured post-operatively. At two weeks post-operatively, both the treatment and control groups had diminished ROM and function compared to pre-operatively. Both groups had increased knee girth compared to pre- operatively. There was no significant difference in ROM, 6MWT, TUG, or knee girth between the 2 groups. We did find a significantly lower amount of narcotic consumption (509 mg morphine equivalents) in the treatment group compared with the control group (680 mg morphine equivalents) at up to two weeks postop, when the cryopneumatic device was being used (p < 0.05). Between two and six weeks, there was no difference in the total amount of narcotics consumed between the two groups. At six weeks, there was a trend toward a greater distance walked in the 6MWT in the treatment group (29.4 meters versus 7.9 meters, p = 0.13). There was a significant difference in the satisfaction scores of patients with their cooling regimen, with greater satisfaction in the treatment group (p < 0.0001). There was no difference in ROM, TUG, VAS, or knee girth at six weeks. There was no difference in adverse events or compliance between the two groups. A cryopneumatic device used after TKA appeared to decrease the need for narcotic medication from hospital discharge to 2 weeks post-operatively. There was also a trend toward a greater distance walked in the 6MWT. Patient satisfaction with the cryopneumatic cooling regimen was significantly higher than with the control treatment.
The Role of Decitabine for the Treatment of Acute Myeloid Leukemia
Authors: Ganetsky Alex 
Published: November 2012

OBJECTIVE: To review the available literature addressing the role of decitabine for the treatment of acute myeloid leukemia (AML). DATA SOURCES: Relevant literature was identified by a PubMed search (January 1970-March 2012) of English-language literature using the terms decitabine, acute myeloid leukemia, and DNA methyltransferase inhibitors. STUDY SELECTION AND DATA EXTRACTION: All published studies and abstracts, as well as relevant consensus guidelines, evaluating the current literature about the role of decitabine for the treatment of AML were included. DATA SYNTHESIS: Decitabine has been evaluated for the treatment of AML in several different settings. In patients with newly diagnosed AML who are not candidates for standard remission induction chemotherapy, a Phase 2 trial of decitabine administered for 5 days per cycle demonstrated a 24% complete remission rate (CR). A subsequent Phase 3 trial comparing decitabine and low-dose cytarabine or best supportive care in a similar patient population showed a greater CR rate (18% vs 8%; p = 0.001) but no overall survival benefit. A Phase 2 trial demonstrated a 47% CR rate with decitabine initially administered for 10 days per cycle, with subsequent doses customized to individual response and toxicity. This novel dosing schedule has yet to be evaluated in a Phase 3 trial. Decitabine is also being investigated for the treatment of relapsed/refractory AML and as bridge therapy to allogeneic hematopoietic stem cell transplantation. CONCLUSIONS: Decitabine offers a promising alternative therapeutic option for patients with AML who are not candidates for standard remission induction chemotherapy. Because of its acceptable safety profile, research is investigating the clinical benefit of decitabine in combination with other antileukemic therapies. The potential roles of decitabine in the treatment of AML continue to be explored in numerous clinical trials.
Continuous and Extended Infusions of β-Lactam Antibiotics in the Pediatric Population
Authors: Walker Mary Covington , Lam Weng Man , Manasco Kalen B 
Published: November 2012

OBJECTIVE: To conduct a systematic review of available data on the use of extended or continuous infusion of β-lactam and monobactam therapy in the pediatric population (aged 0–18 years). DATA SOURCES: A literature search was performed using PubMed (1975-May 2012), International Pharmaceutical Abstracts (1970-May 2012), and Web of Science (1977-May 2012) to identify studies for inclusion. In addition, reference citations from identified publications were reviewed. The following search terms were used: pediatric, children, neonate, infant, adolescent, β-lactam, cephalosporin, carbapenem, penicillin, monobactam, continuous infusion, extended infusion, and/or prolonged infusion. Individual names of drugs in each class of antibiotics were also included in the search. STUDY SELECTION AND DATA EXTRACTION: Randomized controlled clinical trials, pharmacokinetic/pharmacodynamic studies, observational studies, and case reports involving pediatric patients who received extended or continuous infusion of β-lactam or monobactam antibiotics were reviewed. Only English-language publications were included. DATA SYNTHESIS: One randomized controlled clinical trial, 5 pharmacokinetic studies, 2 pharmacodynamic studies using Monte Carlo simulation, 1 case series, and 7 case reports were included in the analysis. The cephalosporin class has been studied the most and currently represents the only clinical trial using a continuous infusion dosing strategy in pediatric patients. There is limited clinical evidence available to support the use of extended or continuous infusion of β-lactam antibiotics in the pediatric population. Pharmacodynamic studies conducted in this population mirror the current evidence in adults for cefepime and meropenem. The single prospective clinical trial using continuous infusion of ceftazidime failed to demonstrate any clinical benefit over traditional dosing; however, there was equal efficacy. CONCLUSIONS: More well-designed prospective clinical trials are required to determine the role of extended or continuous infusion of β-lactam antibiotics in treatment of pediatric patients.
Evaluation of Vitamin B12 Monitoring in a Veteran Population on Long-Term, High-Dose Metformin Therapy
Authors: Pierce Sarah A , Chung Amy H , Black Karen Korch 
Published: November 2012

BACKGROUND: Metformin can result in vitamin B12 deficiency, potentially leading to complications such as neuropathy. Annual monitoring of vitamin B12 has been suggested; however, it is unknown whether current practice reflects this recommendation. OBJECTIVE: To identify vitamin B12 monitoring patterns in patients on long-term, high-dose metformin. Secondary objective was to determine the frequency of new vitamin B12 deficiency, anemia, and neuropathy documented after initiation of high-dose metformin. METHODS: Electronic medical records of veterans treated at the Veterans Affairs Maryland Healthcare System with high-dose metformin (≥2000 mg/day) as of November 1, 2010, were reviewed. Data regarding metformin treatment, vitamin B12 measurements, and documentation of vitamin B12 deficiency, cyanocobalamin supplementation, anemia, and neuropathy were collected. Subjects treated with metformin for less than 1 year or those with documented peripheral neuropathy, megaloblastic anemia, vitamin B12 deficiency, or a condition associated with vitamin B12 malabsorption prior to metformin initiation were excluded. RESULTS: Subjects (N = 235) had a mean metformin dose of 2050 mg/day and mean duration of treatment of 5.2 years. Sixty percent did not have vitamin B12 measured. Of subjects receiving metformin for 10 years or more, nearly half (46%) never had vitamin B12 measured. New documentation of vitamin B12 deficiency or cyanocobalamin supplementation was found in 5.5% of the population, and anemia was found in 12%. Of the 14% with new neuropathy, 42% did not have vitamin B12 measured. CONCLUSIONS: Vitamin B12 was not routinely monitored in patients on high-dose metformin, even in those at highest risk (≥10 years of therapy), or in those with potential manifestations of vitamin B12 deficiency (neuropathy). Cases of vitamin B12 deficiency and resulting anemia or neuropathy may be undiagnosed and untreated because of lack of monitoring. Prospective studies examining the effect of increased vitamin B12 monitoring on identification and treatment of vitamin B12 deficiency in patients on metformin are warranted.
A Probable Interaction between Warfarin and the Antiretroviral TRIO Study Regimen
Authors: Liedtke Michelle D , Vanguri Amulya , Rathbun R Chris 
Published: November 2012

OBJECTIVE: To report a probable drug interaction between the antiretroviral TRIO regimen (ritonavir-boosted darunavir, etravirine, and raltegravir) and warfarin in an HIV-infected patient. CASE SUMMARY: In January 2010, a 50-year-old transgender female with HIV infection and recurrent deep vein thrombosis began treatment with the TRIO study regimen. Treatment had been maintained with warfarin for the past 5 years and emtricitabine monotherapy for the preceding 22 months. Emtricitabine was discontinued when the TRIO regimen was started. The mean weekly warfarin dose while the patient was receiving emtricitabine monotherapy was 13.3 mg (95% CI 12.7 to 13.8), with a mean international normalized ratio (INR) of 2.8 (95% CI 2.5 to 3.1). Following the initiation of the TRIO regimen, the mean weekly warfarin dose was increased to 19.3 mg (95% CI 18.5 to 20.1) and was maintained over the ensuing 71 weeks with a mean INR of 2.6 (95% CI 2.2 to 3.0). DISCUSSION: Information on the effect of newer antiretrovirals on warfarin metabolism, as well as the collective contribution of combination antiretroviral therapy including multiple agents that may alter warfarin metabolism, is limited. We predicted that warfarin dose requirements would change upon initiation of the TRIO regimen. Given the variability in INR that can occur with chronic warfarin treatment, weekly warfarin doses were averaged during emtricitabine monotherapy (90 weeks) and TRIO regimen (71 weeks) periods. Mean weekly warfarin doses increased by 45% (p < 0.001) following initiation of the TRIO regimen. Mean INR results for the 2 time periods were not significantly different, demonstrating that stable anticoagulation was maintained. The Horn drug interaction probability scale score to assess causation indicated a probable interaction. CONCLUSIONS: An increased weekly warfarin dose requirement is predicted when warfarin is used concurrently with the antiretroviral TRIO regimen. Increased INR monitoring is prudent when the combination is administered.
Bevacizumab-Induced Oral Mucositis in Background of Cutaneous Plaque-Type Psoriasis
Authors: Popa Andra M , Valla Kelly , Radhakrishnan Latha , Cuellar Sandra , Villano J Lee 
Published: November 2012

OBJECTIVE: To report the serial development of oral mucositis following infusion of bevacizumab in a young woman with a malignant brain tumor and history of cutaneous psoriasis. CASE SUMMARY: A 29-year-old woman with a history of active cutaneous psoriasis and a malignant glioneuronal tumor was treated with bevacizumab for 2.5 years. With each infusion of bevacizumab, she developed oral mucositis within 36 hours. She received temozolomide as part of concurrent therapy with radiation and as maintenance therapy; it was discontinued after continuous therapy for 1.5 years. Bevacizumab 10 mg/kg was added after 7 cycles of maintenance temozolomide, as the tumor had minimal response and evidence of increased perfusion with angiogenesis on imaging studies. All medication, including temozolomide, was evaluated and eventually discontinued, with the exception of bevacizumab, which remained the drug suspected of causing the mucositis. DISCUSSION: Oral mucositis is a frequent adverse effect of cytotoxic chemotherapy, but has not been reported with bevacizumab. The Naranjo probability scale indicated a probable adverse drug reaction. This likely indicates that bevacizumab is one of many drugs known to induce exacerbation of psoriatic disease. We speculate that oral mucositis developed as bevacizumab-induced generation of proinflammatory cytokines within the vascular endothelium, leading to mucosal damage and ulceration. In addition, interruption of reparative angiogenic pathways with bevacizumab likely contributed to the severity of mucositis. CONCLUSIONS: Clinicians should be aware that bevacizumab can potentially exacerbate psoriatic disease.