bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of a postgraduate six-month rotation in palliative care on knowledge and attitudes of junior residents
Authors: Duong Phuc H , Zulian Gilbert B 
Published: June 2006

Fifty junior residents completed a six-month training period. An anonymous postal questionnaire was sent to collect the residents' opinions on improvements in their knowledge, perception of priorities and usefulness of training. Responses were rated from 5 (a great deal) to 1 (not at all improved). A total of 33 (66%) questionnaires were returned. A mean score of 4.48 was obtained on general improvement of knowledge, 4.91 ± 0.29 on pain control, 4.17 ± 0.58 on neurological symptoms, 4.09 ± 0.77 on psychological symptoms, 4.64 ± 0.60 on communication skills and 4.4 ± 0.91 on physician attitudes. Some 58% of residents began the training with apprehension, 85% outlined their priorities and 76% reached these objectives. A total of 70% were fully satisfied with the tuition and support received and 98% recommended such clinical rotation. Data suggest that a six-month rotation in palliative care results in high levels of perception of improvement in knowledge and satisfaction. Exposure to palliative care patients during clinical rotations in specialized centres must be encouraged.
Violence and psychiatric morbidity in the national household population of Britain: public health implications
Authors: Coid Jeremy , Yang Min , Roberts Amanda , Ullrich Simone , Moran Paul , Bebbington Paul , Brugha Traolach , Jenkins Rachel , Farrell Michael , Lewis Glyn , Singleton Nicola 
Published: June 2006

BackgroundIt is unclear whether psychiatric morbidity contributes to the small proportion of the population responsible for a large percentage of antisocial behaviour, including violence.AimsTo measure associations between psychiatric morbidity and severity chronicity and types of victims of violence in the national household population of Britain.MethodCross-sectional survey of persons in households (n=8397). Data included self-reported location, victims and outcome of violence over the previous 5 years. Diagnoses were determined by computer-assisted interviews.ResultsHazardous drinking was associated with over half of all incidents involving injury. Antisocial personality disorder conveyed an attributable risk of 24% of respondents reporting victim injuries, but screening positive for psychosis conveyed an attributable risk of only 1.2%.ConclusionsThe burden of care resulting from violence associated with hazardous drinking supports population interventions. Despite exceptional risks, half of respondents with antisocial personality disorder were not violent, indicating limitations in targeted interventions to detain high-risk individuals.
Generalisability of the individual placement and support model of supported employment: results of a Canadian randomised controlled trial
Authors: Latimer Eric A. , Lecomte Tania , Becker Deborah R. , Drake Robert E. , Duclos Isabelle , Piat Myra , Lahaie Nicole , St-Pierre Marie-Sylvie , Therrien Claude , Xie Haiyi 
Published: June 2006

BackgroundStudies conducted in the USA have found the individual placement and support model of supported employment to be more effective than traditional vocational rehabilitation at helping people with severe mental illness to find and maintain competitive employment.AimsTo determine the effectiveness of the individual placement and support (supported employment) model in a Canadian setting.MethodA total of 150 adults with severe mental illness, who were not currently employed and who desired competitive employment, were randomly assigned to receive either supported employment (n=75) or traditional vocational services (n=75).ResultsOver the 12 months of follow-up, 47% of clients in the supported employment group obtained at least some competitive employment, v. 18% of the control group (P<0.001). They averaged 126 h of competitive work, v. 72 inthe control group (P<0.001).ConclusionsSupported employment proved more effective than traditional vocational services in a setting significantly different from settings in the USA, and may therefore be generalised to settings in other countries.
Vascular risk factors and incident late-life depression in a Korean population
Authors: Kim Jae-Min , Stewart Robert , Kim Sung-Wan , Yang Su-Jin , Shin Il-Seon , Yoon Jin-Sang 
Published: June 2006

BackgroundCausal relationships between vascular factors and late-life depression are controversial.AimsTo investigate prospective associations between risk factors for vascular disease and incidence of late-life depression.MethodOf 661 community participants aged 65 years or over, without depression at baseline, 521 (79%) were re-evaluated 2 years later. At baseline and follow-up, a diagnostic interview for depression was carried out and information on vascular status, disability and cognitive function was gathered.ResultsPre-existing heart disease, incident stroke and lower baseline high-density lipoprotein cholesterol level were significantly associated with incidence of late-life depression, independently of disability and cognitive function.ConclusionsThese results provide some support for a vascular aetiology of late-life depression. However, important risk factors for cerebrovascular disease such as hypertension and diabetes were not implicated, and the associations with lipid levels might still be explained by affective states earlier in life.
Initial treatment phase in early psychosis: can intensive home treatment prevent admission?
Authors: Gould Matthew , Theodore Kate , Pilling Stephen , Bebbington Paul , Hinton Mark , Johnson Sonia 
Published: June 2006

Aims and MethodThe aim of this study was to describe the early treatment phase in first-episode psychosis in an area with well-established crisis resolution teams. Socio-demographic characteristics and patterns of initial treatment were investigated for all individuals with first-episode psychosis identified prospectively over a 1-year period in two London boroughs.ResultsOver a year, 111 people presented with first-episode psychosis. Fifty-one people (46%) were initially managed in the community, with the remaining 60 (54%) admitted to in-patient units immediately. By 3 months after presentation, a total of 80 people (72%) had been admitted and 54 (49%) had been compulsorily detained under the Mental Health Act 1983. Thirty-three people were initially managed by the crisis resolution teams and 15 of these were eventually admitted.Clinical ImplicationsIn a catchment area in which alternatives to admission are well developed, the admission rate for first-episode psychosis was still high.
Diagnosis and management of attention-deficit hyperactivity disorder in children and adults with and without learning disability
Authors: Buckley Sarah , Dodd Philip , Burke Amanda , Guerin Suzanne , McEvoy John , Hillery John 
Published: June 2006

Aims and MethodAnecdotal evidence suggests that attention-deficit hyperactivity disorder (ADHD) is underdiagnosed in adults and people of all ages with learning disability. This study examines the clinical practice of Irish consultant psychiatrists when assessing and treating symptoms of ADHD in children and adults with and without a learning disability. A postal questionnaire was sent to 302 consultant psychiatrists working in Ireland.ResultsNinety-seven consultants (32%) responded, 62 working in general adult psychiatry, 23 in child and adolescent psychiatry and 12 in learning disability. Overall, respondents were more confident about making a diagnosis of ADHD in people without a learning disability. Those working with children were significantly more confident in diagnosing and treating ADHD than those working with adults, irrespective of whether the patient had a learning disability.Clinical ImplicationsThere is general agreement that symptoms of ADHD exist in children and adults both with and without a learning disability. It is likely that ADHD may be undertreated in patients with learning disability, especially in the adult population.
Violence, stigma and psychiatric diagnosis: the effects of a history of violence on psychiatric diagnosis
Authors: Clark Tom , Rowe Renarta 
Published: June 2006

Aims and MethodThe aim of the study was to investigate whether psychiatrists consider that patients with schizophrenia present a greater risk of violence than patients with other forms of mental illness. Two pairs of clinical vignettes were devised. In each pair, one contained a history of violence and one did not. One vignette was mailed to each of 2000 consultant psychiatrists in the UK. Respondents were asked to give a preferred diagnosis. Rates of diagnosis of bipolar disorder, schizoaffective disorder and schizophrenia were compared within vignette pairs.ResultsFor each pair of vignettes, the rate of diagnosis of schizophrenia was higher (33v.21.5%,P=0.008 and 44.4v.32.1%,P=0.011), and the rate of diagnosis of bipolar disorder was lower (44.2v.62.6%,P<0.0005 and 34.9v.49.3%,P=0.004), among those who received the vignette containing a history of violence.Clinical ImplicationsA history of violence may lead to an increased likelihood of receiving a diagnosis of schizophrenia as opposed to bipolar affective disorder. This bias in diagnostic decision-making may affect the treatment received by a patient and may perpetuate and exacerbate the stigma associated with a diagnosis of schizophrenia.
Validation of a short instrument to measure stigmatised attitudes towards mental illness
Authors: Luty Jason , Fekadu Daniel , Umoh Okon , Gallagher John 
Published: June 2006

Aims and MethodOne of the steps to change stigmatised attitudes involves identifying the concerns of people whose attitude is to be changed. This paper presents the Attitudes to Mental Illness Questionnaire (AMIQ), a short instrument aimed at systematically obtaining this information, and examines the feasibility, test–retest reliability as well as face and construct validity of the AMIQ on the UK general public. A postal survey of a random sample of 1079 adults was conducted. A self-reported questionnaire with 5-point Likert scale responses was validated in response to short fictional vignettes. A second subsample of 256 was used for a reliability test.ResultsThe AMIQ is a short instrument with good psychometric properties. It shows good stability, test–retest reliability, alternative test reliability, face, construct and criterion validity. The self-selecting sample of 1079 UK adults showed highly stigmatised attitudes to people with addictive disorders but more positive attitudes to those with depression or self-harm. Results from a smaller follow-up sample showed that attitudes towards people with alcohol dependence and schizophrenia were intermediate.Clinical ImplicationsThe AMIQ can be used in various medical and mental health stigma research and intervention settings.
A survey of liaison psychiatry services in general hospitals and accident and emergency departments: do we have the balance right?
Authors: Kewley Tamsin , Bolton Jim 
Published: June 2006

Aims and MethodBy use of a telephone survey, we aimed to investigate liaison psychiatry services of all 29 general hospitals in Greater London. We specifically enquired about services to accident and emergency (A&E) departments.ResultsWe identified wide variations in staffing, working hours and patient groups seen. Fourteen services (48%) worked over 24 h and 4 (14%) had specific A&E teams. Twelve services (41%) had established or planned working links with community crisis services.Clinical ImplicationsGenerally staff numbers fell below national recommendations and there were frequent gaps in service provision. The recent focus on emergency care has lead to an increase in A&E services, but there is a risk that liaison psychiatry services for other general hospital patients are being neglected.
Knowledge of deep vein thrombosis among intravenous drug misusers
Authors: Williams Karen , Abbey Emma 
Published: June 2006

Aims and MethodAll patients attending the local supervised drug consumption clinics were surveyed over a month. They were asked via a questionnaire to list the risks of injecting drugs, particularly the symptoms and consequences of deep vein thrombosis (DVT). Of 69 patients surveyed, 46 agreed to take part.ResultsOnly 9 patients (20%) had never injected drugs, whereas 16 (43%) of those injecting had injected into the groin; 10 patients (22%) had experienced a venous thrombosis themselves, and 35 (76%) knew of someone who had. Only 30 (65%) knew what a clot or thrombosis was. Pain and swelling were the most commonly reported symptoms, but few drug misusers knew of other symptoms. The best informed were those who had experienced thrombosis themselves recently.Clinical ImplicationsThe results indicate an apparent lack of basic knowledge about the risks of DVT in this sample of drug misusers, and a need for some new initiatives to address health education in this area for all drug misusers.
Service innovations: redesigning a community mental health team
Authors: Shajahan Polash , Forde Frances , McIntosh Mary , Moffat Vicki , Munogee Pravin 
Published: June 2006

Aims and MethodWe describe the redesign of a community mental health team in Lanarkshire (the focused intervention team for Bellshill). Their remit is to provide focused, time-limited therapeutic intervention for patients with mild-to-moderate mental health problems.ResultsThe redesign involved a closer working relationship with the psychiatrist, establishing a concurrent community psychiatric nurse/ psychiatric clinic, recategorisation of ‘soon’ and routine referrals to the team, opt-in letters and the introduction of new assessment formats.Clinical ImplicationsThese measures combined to provide a shorter waiting list, increased joint working and management plans for patients. Team functioning and morale improved.
Effectiveness of the research day in psychiatric training: survey of consultant psychiatrists
Authors: Okolo Dennis , Ogundipe Laofe O. 
Published: June 2006

Aims and MethodWe explored the views of consultant psychiatrists (trainers and non-trainers) on the effectiveness of the research day. We sent out postal questionnaires to consultant psychiatrists in general adult and old age psychiatry in the West Midlands to evaluate their own experience of the research day and how useful they felt it was.ResultsThe survey had a response rate of 72% (88 out of 122) and the majority of respondents had a positive view of their experience (31 trainers, 60%; 25 non-trainers, 69%). However, more consultant trainers (37, 71%) compared with non-trainers (15, 42%) felt that the research day in its current format should be modified.Clinical ImplicationsThe research day is useful for the training of specialist registrars and our study confirms this view from the consultants surveyed. Some improvement is required in order for specialist registrars to obtain optimal benefit. We make some suggestions for improving the day's effectiveness.
HER2 Testing by Local, Central, and Reference Laboratories in Specimens From the North Central Cancer Treatment Group N9831 Intergroup Adjuvant Trial
Authors: Perez Edith A. , Suman Vera J. , Davidson Nancy E. , Martino Silvana , Kaufman Peter A. , Lingle Wilma L. , Flynn Patrick J. , Ingle James N. , Visscher Daniel , Jenkins Robert B. 
Published: June 2006

Purpose To evaluate concordance between local and central laboratory HER2 testing results in patients from the North Central Cancer Treatment Group (NCCTG) N9831 adjuvant trial of trastuzumab. Patients and Methods NCCTG N9831 is a randomized, phase III clinical trial comparing three drug regimens: doxorubicin/cyclophosphamide followed by paclitaxel with trastuzumab added concurrently, sequentially, or not at all as adjuvant therapy for women with HER2-positive resected breast cancer. Originally, patients were eligible if their tumors were HER2 positive by either local laboratory immunohistochemistry (IHC) or fluorescence in situ hybridization (FISH). A protocol modification in 2002 made central laboratory testing mandatory, with additional testing of discordant cases conducted by a reference laboratory. Concordance between local and central laboratory, and level of agreement between central and reference laboratory HER2 findings in discordant cases were examined. Results HER2 positivity was confirmed in 85.8% of 2,535 patients registered since March 2002. When local and central evaluation used the same methodology, concordance was 88.1% for FISH and 81.6% for a diagnostic test for presence of the HER2 protein. Among discordant cases examined at the reference laboratory, there was 94.3% agreement for IHC (0, 1+, 2+) and 95.2% agreement for FISH (not gene amplified). Conclusion There was a high degree of discordance between local and central testing for IHC and FISH, but a high degree of agreement between central and reference laboratories. These findings support the importance of using high-volume, experienced laboratories for HER2 testing to improve the process of selecting patients likely to benefit from trastuzumab therapy.
Molecular Load of Pathologically Occult Metastases in Pelvic Lymph Nodes Is an Independent Prognostic Marker of Biochemical Failure After Localized Prostate Cancer Treatment
Authors: Ferrari Anna C. , Stone Nelson N. , Kurek Ralf , Mulligan Elizabeth , McGregor Roy , Stock Richard , Unger Pamela , Tunn Ulf , Kaisary Amir , Droller Michael , Hall Simon , Renneberg Heiner , Livak Kenneth J. , Gallagher Robert E. , Mandeli John 
Published: June 2006

Purpose Thirty percent of patients treated with curative intent for localized prostate cancer (PC) experience biochemical recurrence (BCR) with rising serum prostate-specific antigen (sPSA), and of these, approximately 50% succumb to progressive disease. More discriminatory staging procedures are needed to identify occult micrometastases that spawn BCR. Patients and Methods PSA mRNA copies in pathologically normal pelvic lymph nodes (N0-PLN) from 341 localized PC patients were quantified by real-time reverse-transcriptase polymerase chain reaction. Based on comparisons with normal lymph nodes and PLN with metastases and on normalization to 5 × 106 glyceraldehyde-3′-phosphate dehydrogenase mRNA copies, normalized PSA copies (PSA-N) and a threshold of PSA-N 100 or more were selected for continuous and categorical multivariate analyses of biochemical failure-free survival (BFFS) compared with established risk factors. Results At median follow-up of 4 years, the BFFS of patients with PSA-N 100 or more versus PSA-N less than 100 was 55% and 77% (P = .0002), respectively. The effect was greatest for sPSA greater than 20 ng/mL, 25% versus 60% (P = .014), Gleason score 8 or higher, 21% versus 66% (P = .0002), stage T3c, 18% versus 64% (P = .001), and high-risk group (50% v 72%; P = .05). By continuous analysis PSA-N was an independent prognostic marker for BCR (P = .049) with a hazard ratio of 1.25 (95% CI, 1.001 to 1.57). By categorical analysis, PSA-N 100 or more was an independent variable (P = .021) with a relative risk of 1.98 (95% CI, 1.11 to 3.55) for BCR compared with PSA-N less than 100. Conclusion PSA-N 100 or more is a new, independent molecular staging criterion for localized PC that identifies high-risk group patients with clinically relevant occult micrometastases in N0-PLN, who may benefit from additional therapy to prevent BCR.
Phase II Multicenter Study of Neoadjuvant Biochemotherapy for Patients With Stage III Malignant Melanoma
Authors: Lewis Karl D. , Robinson William A. , McCarter Martin , Pearlman Nathan , O'Day Steven J. , Anderson Clay , Amatruda Thomas T. , Baron Anna , Zeng Chan , Becker Maude , Dollarhide Susan , Matijevich Karen , Gonzalez Rene 
Published: June 2006

Purpose To determine the relapse-free survival, overall survival, and response rate of patients with stage III melanoma treated with neoadjuvant biochemotherapy in a multicenter setting. Patients and Methods Patients with pathologically proven stage III melanoma, either via clinical detection or sentinel lymph node positivity, were eligible for enrollment. Patients received two cycles of preoperative biochemotherapy followed by complete regional lymphadenectomy and two postoperative courses of biochemotherapy. The biochemotherapy regimen consisted of the following: cisplatin 20 mg/m2 on days 1 to 4, dacarbazine 800 mg/m2 on day 1 only, vinblastine 1.6 mg/m2 on days 1 to 4, interleukin-2 total dose of 36 MU/m2 during 4 days, and interferon alfa 5 MU/m2 on days 1 to 5. Growth factor support was administered with each cycle. Results Ninety-two patients were eligible for the study. At a median follow-up of 40.4 months, relapse-free survival and overall survival are 64% and 78%, respectively. There was a lower relapse rate and improved survival for patients with a positive sentinel lymph node compared with patients with clinically detected lymph nodes, although this difference did not reach statistical significance. Of the 50 patients with measurable disease, the overall response rate was 26%. Toxicity of the biochemotherapy was high but generally manageable. Conclusion The current study has expanded the preliminary evidence on neoadjuvant biochemotherapy for stage III melanoma.
Progression-Free Survival Rate As Primary End Point for Phase II Cancer Clinical Trials: Application to Mesothelioma—The EORTC Lung Cancer Group
Authors: Francart Julie , Legrand Catherine , Sylvester Richard , Van Glabbeke Martine , van Meerbeeck Jan P. , Robert Annie 
Published: June 2006

PurposePhase II cancer clinical trials play a key role in the development of new drugs. These trials should be designed to accurately determine if the drug should be abandoned or if it is sufficiently promising for further investigation in phase III trials. With new cytostatic agents or when the response assessment is difficult, using the progression-free survival rate (PFSR) at a fixed time point, such as 3, 4, 5, or 6 months, instead of the response rate (RR) as the primary end point is an alternative approach. To design future phase II trials, reference values for PFSRs that correspond to drugs with insufficient (P0) and sufficient (P1) clinical activity (CA) are necessary. This article provides these values in mesothelioma.Materials and MethodsThe European Organisation for Research and Treatment of Cancer database registered ten closed mesothelioma trials (nine phase II trials and one phase III trial) with 523 total patients. Trials were grouped into three categories according to the published RR: significant (n = 259), moderate (n = 142), and insufficient (n = 122) CA.ResultsThe PFSRs at 3, 4, 5, and 6 months, respectively, were as follows: 72%, 67%, 51%, and 43% in the group with significant CA; 59%, 51%, 42%, and 35% with moderate CA; and 52%, 40%, 34%, and 28% with insufficient CA.ConclusionThese values may be used to define relevant P0 and P1 values in future phase II mesothelioma trials that use PFSR as the primary end point.