bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comprehension of affective prosody in multiple sclerosis
Authors: Beatty William W , Orbelo Diana M , Sorocco Kristen H , Ross Elliott D 
Published: March 2003

Deficits in cognition have been repeatedly documented in patients with multiple sclerosis (MS), but their ability to comprehend emotional information has received little study. Forty-seven patients with MS and 19 demographic controls received the comprehension portion of the A prosodia Battery, which is known to be sensitive to the impairments of patients with strokes and other neurological conditions. Patients also received tests of hearing, verbal comprehension and naming, a short cognitive battery, and the Beck Depression Inventory. Patients with MS were impaired in identifying emotional states from prosodic cues. The magnitude of the deficits was greatest for patients with severe physical disability and under test conditions of limited prosodic information. Correlational analyses suggested that the patients’ difficulties in comprehending affective prosodic information were not secondary to hearing loss, aphasic deficits, cognitive impairment, or depression. For some patients with MS, deficits in comprehending emotional information may contribute to their difficulties in maintaining effective social interactions.
Rationale and design of a clinical trial of a low-molecular-weight heparin in preventing clinically important venous thromboembolism in medical patients: the Prospective Evaluation of Dalteparin efficacy for Prevention of Venous Thromboembolism in Immobilized Patients Trial (the PREVENT study)
Authors:   The PREVENT Investigator Group
Published: April 2003

The utility of low-molecular-weight heparin (LMWH) in the prophylaxis of venous thromboembolic disease has been examined using the surrogate endpoint of venographically identified thrombi. The largest portion of these thrombi were asymptomatic calf-vein thrombi. The clinical relevance of this observation is a matter of debate. The present study is designed to evaluate the impact of an LMWH on clinically important endpoints. The current study is a randomized, prospective, double-blinded, multicenter, multinational, controlled clinical trial comparing dalteparin with placebo in moderately high-risk hospitalized medical patients. A total of 3300 patients will be randomized to receive either 5000 IU per day of dalteparin or placebo for 14 days. Patients will undergo appropriate evaluation for any symptomatic episodes and all patients will undergo a bilateral compression ultrasound (CUS) on day 21 to search for asymptomatic proximal thrombi. The primary endpoint is the combination of objectively confirmed symptomatic deep vein thrombi (DVT), fatal or non-fatal pulmonary emboli, all proximal DVT, and sudden death. This study will be the first study to examine clinically important endpoints in evaluating the effect of a LMWH in hospitalized medical patients. This study also is the first study to use CUS rather than venography in concordance with contemporary medical practice. This trial is thus designed to address this important question in a clinically relevant manner.
Antiphospholipid antibodies in thromboangiitis obliterans
Authors: Maslowski Leszek , McBane Robert , Alexewicz Pawel , Wysokinski Waldemar E 
Published: April 2003

Thromboangiitis obliterans (TAO) and antiphospholipid syndrome (APS) share the clinical characteristics of arterial thrombosis and recurrent thrombophlebitis. Although the association of anticardiolipin antibodies (aCLa) and TAO has been previously recognized, the prevalence and the clinical impact of this association remains unclear. aCLa were measured by double ELISA in patients with TAO (n=47), premature atherosclerosis (pASO) (n=48) and otherwise healthy individuals (n=48). Antibody status was then compared to clinical presentation and outcomes in patients meeting the diagnostic criteria for TAO. The prevalence of aCLa was significantly higher in patients with TAO (36%) compared to either pASO (8%; p=0.01) or healthy individuals (2%; p,0.001). Patients with TAO and a high antibody titer tended to be younger and suffer a significantly higher rate of major amputations compared to those without the antibody (100% versus 17%; p=0.003). Clinical features of TAO not significantly altered by the presence of aCLa included upper limb involvement, digital necrosis, superficial thrombophlebitis (or deep venous thrombosis). Protein C, protein S, and anti-thrombin III were normal in all individuals. TAO is associated with an increased prevalence of aCLa. The presence of a high antibody titer in these patients is associated with increased morbidity, including major limb amputation. In patients meeting the diagnostic criteria for TAO, screening for aCLa should be considered. Although attractive, the efficacy of chronic anticoagulation in this setting remains to be proven.
The use of Ginkgo biloba in Raynaud’s disease: a double-blind placebo-controlled trial
Authors: Muir Andrew H , Robb Rosalind , McLaren Margaret , Daly Fergus , Belch Jill JF 
Published: April 2003

Raynaud’s phenomenon (RP) is a common and painful condition characterized by episodic digital ischaemia produced by emotion and cold. Treatment of RP is notoriously difficult because of the high incidence of side effects. The aim of our study was to investigate the clinical efficacy of a standardized Ginkgo biloba extract (Seredrin) in the treatment of RP in patients with no apparent, associated condition such as systemic sclerosis. A two-week assessment period was done during which patients were asked to record frequency, severity and duration of attacks in diaries. Subjects were then randomized independently of the study centre to receive either active or placebo treatment for 10 weeks, during which time the same data were recorded in their diaries. Patients were seen after two and four weeks of treatment and at the end of the 10-week treatment phase. Blood samples pre- and post-treatment were taken for haemorrheology. Only in the number of attacks per day was there a significant effect of treatment over placebo. The number of attacks per week prior to treatment with Seredrin was 13.2 6 16.5 reducing to 5.8 6 8.3, a reduction of 56%, whereas placebo reduced the number by only 27% (p < 0.00001). There were no significant differences in haemorrheology between the two groups. Ginkgo biloba phytosome may be effective in reducing the number of Raynaud’s attacks per week in patients suffering from Raynaud’s disease.
Clinical benefit of renal artery angioplasty with stenting for the control of recurrent and refractory congestive heart failure
Authors: Gray Bruce H , Olin Jeffrey W , Childs Mary Beth , Sullivan Timothy M , Bacharach J Michael 
Published: April 2003

Renal artery stenosis (RAS) may cause hypertension, azotemia, episodes of flash pulmonary edema and congestive heart failure. Renal artery angioplasty and stenting was performed in 207 patients from 1991 to 1997. Thirty-nine of these patients (19%) underwent renal artery stenting for the control of recurrent episodes of congestive heart failure and flash pulmonary edema. All patients had angiographic evidence of severe (>70%) bilateral RAS (n = 18) or severe RAS to a solitary functioning kidney (n = 21). Sixteen patients (41%) were male and 23 (59%) were female, mean age 69.9 years (range 50- 85 years). Of the 18 patients with bilateral RAS, 12 (66.6%) underwent bilateral stenting. Mean blood pressure decreased from 174/85 6 32/23 mmHg to 148/72 6 24/14 mmHg (p < 0.001). Mean number of blood pressure medications decreased from 3 6 1 to 2.5 6 1 (p = 0.006). Twenty-eight patients (71.8%) had improvement in blood pressure control. The mean serum creatinine decreased from 3.16 6 1.61 to 2.65 6 1.87 (p = 0.06). Six of 39 patients (15.4%) used angiotensin converting enzyme (ACE) inhibitors prior to stenting whereas 19 of 39 patients (48.7%) used ACE inhibitors poststenting (p = 0.004). Twenty of 39 patients (51.4%) demonstrated improvement in serum creatinine, 10 of 39 patients (25.6%) had stabilization of serum creatinine and nine of 39 patients (23%) demonstrated worsening. The number of hospitalizations due to congestive heart failure in the year preceding renal artery stenting was 2.4 6 1.4 and poststenting was 0.3 6 0.7 (p < 0.001). The New York Heart Association Functional Class decreased from 2.9 6 0.9 prestenting to 1.6 6 0.9 poststenting (p < 0.001). Thirty of 39 patients (77%) had no hospitalizations for congestive heart failure during a mean follow-up period of 21.3 months. Nine patients expired during the course of follow up; eight of the nine patients died within the first year after renal artery stenting. Renal artery stenting decreased the frequency of congestive heart failure, flash pulmonary edema, and the need for hospitalization in most patients. Blood pressure was markedly improved in the majority of patients with improved or stabilized renal function. Evaluation for RAS is important in hypertensive patients who present with recurrent congestive heart failure or flash pulmonary edema.
Vascular viewpoint
Authors: Hackam Daniel , Anand Sonia S 
Published: April 2003

Question: Does oral acetylcysteine prevent acute contrast nephropathy in patients with moderate renal impairment who undergo elective coronary angiography? Population: Patients with moderate stable renal insufficiency (creatinine clearance,60 ml/min or serum creatinine .1.2 mg/dl [106 mmol/l]) who were scheduled to undergo elective coronary angiography with or without intervention. Design and methods: Randomized placebo-controlled trial. A total of 200 patients were randomized to either oral acetylcysteine 600 mg BID (n = 102) or matching placebo (n = 98). Treatment was given for a total of four doses, starting the day before angiography and continuing on the day of the procedure. All patients received intravenous normal saline for 12 hours before and 6 hours after contrast exposure, and low osmolality contrast agents. Primary outcome was the occurrence of more than a 25% increase in serum creatinine level within 48 hours after contrast exposure. Coprimary outcomes were a change in creatinine clearance and serum creatinine level. Secondary outcomes were major adverse cardiac events, need for dialysis, and length of hospitalization. Patients, caregivers, and outcome assessors were blinded to group assignment. Analysis was by intention-to-treat. Results: Within 48 hours after contrast administration 12/98 (12%) control patients and 4/102 (4%) acetylcysteine patients developed a more than 25% increase in serum creatinine level. Relative risk = 0.32 (95% CI: 0.10--0.96; p = 0.03). Serum creatinine was lower in the acetylcysteine group than in the control group during the first 48 hours after angiography (1.22 mg/dl [108 mmol/l] vs 1.38 mg/dl [122.9 mmol/l]; p = 0.006), but this difference was no longer significant at seven days. Creatinine clearance increased significantly more in the acetylcysteine group than in the placebo group at day two [+30% vs +5%; p < 0.001] and at day seven [+23% vs +15%; p = 0.045]. The average length of stay was half a day shorter in the group receiving acetylcysteine(p = 0.02). No patients in either group required dialysis. There were no treatment-related adverse events. Conclusions: Acetylcysteine safely and effectively reduces the incidence of contrast-induced nephropathy in patients with moderate renal insufficiency undergoing coronary angiography.
Re-examining thought insertion
Authors: Mullins Simon , Spence Sean A. 
Published: April 2003

BackgroundThought insertion is commonly regarded as diagnostic of schizophrenia. Little is known of its aetiology or pathophysiology.AimsTo examine the definition and application of thought insertion in psychiatric and allied literatures.MethodA semi-structured literature review and conceptual analysis.ResultsWhen ‘narrowly’ defined, thought insertion is reliably identified but not specific to schizophrenia. There is a range of related phenomena (‘alienated’, ‘influenced’, ‘made’ and ‘passivity’ thinking), less consistently defined but also not specific to schizophrenia. Whether thought insertion is solely an abnormal belief (or may also be an experience) is open to question. Nevertheless, the symptom has been used to explain schizophrenia, predict dangerousness and advance theories of ‘normal’ agency. Most applications have been subject to critique.ConclusionsDespite its widespread occurrence and diagnostic application, thought insertion is an ill-understood and under researched symptom of psychosis. Its pathophysiology remains obscure.
Providing treatment to prisoners with mental disorders: development of a policy
Authors: Earthrowl Mark , O'Grady John , Birmingham Luke 
Published: March 2003

BackgroundMental disorder is more prevalent among people in prison than in the general population. Prisoners who require transfer to psychiatric hospitals for treatment face long delays. Doctors working in prisons regularly face ethical and legal dilemmas posed by prisoners with mental illness.AimsTo develop a policy for providing treatment under the common law to prisoners with mental disorders who lack treatment decision-making capacity while arrangements are made to transfer them to hospital.MethodThe policy was developed through literature review and consultation with the Faculty of Law at Southampton University and health care staff at Winchester prison in the UK.ResultsThe policy provides guidelines for establishing decision-making capacity standards for documentation, and guidelines for implementation based on the Mental Health Act Code of Practice, other best-practice guidelines and case law.ConclusionsIt can be argued that case law allows more-extensive treatment to be provided in the best interests of the incompetent prisoner, beyond emergency situations. The policy has ethical implications and its use should be carefully monitored.
Tayside–Fife clinical trial of cognitive–behavioural therapy for medication-resistant psychotic symptoms
Authors: Durham Robert C. , Guthrie Moyra , Morton R. Victor , Reid David A. , Treliving Linda R. , Fowler David , MacDonald Ranald R. 
Published: April 2003

BackgroundEvidence for the efficacy of cognitive–behavioural therapy for schizophrenia is promising but evidence for clinical effectiveness is limited.AimsTo test the effectiveness of cognitive–behavioural therapy delivered by clinical nurse specialists in routine practice.MethodOf 274 referrals, 66 were allocated randomly to 9 months of treatment as usual (TAU), cognitive–behavioural therapy plus TAU (CBT) or supportive psychotherapy plus TAU (SPT) and followed up for 3 months.ResultsTreatment effects were modest but the CBT condition gave significantly greater improvement in overall symptom severity than the SPT or TAU conditions combined (F (1,53)=4.14; P=0.05). Both the CBT and SPT conditions combined gave significantly greater improvement in severity of delusions than did the TAU condition (F (1,53)=4.83; P=0.03). Clinically significant improvements were achieved by 7/21 in the CBT condition (33%), 3/19 in the SPT condition (16%) and 2/17 in the TAU condition (12%).ConclusionsCognitive–behavioural therapy delivered by clinical nurse specialists is a helpful adjunct to routine care for some people with chronic psychosis.
Exposure therapy and sertraline in social phobia: 1-year follow-up of a randomised controlled trial
Authors: Haug Tone Tangen , Blomhoff Svein , Hellstrøm Kerstin , Holme Ingar , Humble Mats , Madsbu Hans Petter , Wold Jan Egil 
Published: April 2003

BackgroundMaintenance of treatment effect is important for the choice of treatment for social phobia.AimsTo examine the effect of exposure therapy and sertraline 28 weeks after cessation of medical treatment.MethodIn this study 375 patients with social phobia were randomised to treatment with sertraline or placebo for 24 weeks, with or without the addition of exposure therapy Fifty-two weeks after inclusion, 328 patients were evaluated by the same psychometric tests as at baseline and the end of treatment (24 weeks).ResultsThe exposure therapy group and the placebo group had a further improvement in scores on social phobia during follow-up: mean change in the Clinical Global Impression – Social Phobia overall severity score was 0.45 (95% CI 016–0.65, P < 0.01) for the exposure group, and 0.25 (95% CI 0.00–0.48, P < 0.05) for the placebo group. At week 52 the sertraline plus exposure group and the sertraline-alone group had a significant deterioration on the 36-item Short Form Health Survey compared with exposure alone.ConclusionsExposure therapy alone yielded a further improvement during follow-up, whereas exposure therapy combined with sertraline and sertraline alone showed a tendency towards deterioration after the completion of treatment.
Risk factors for the development of lithium-induced polyuria
Authors: Movig K. L. L. , Baumgarten R. , Leufkens H. G. M. , Van Laarhoven J. H. M. , Egberts A. C. G. 
Published: April 2003

BackgroundPolyuria is common in patients with bipolar disorder treated with lithium. However, the risk factors for polyuria in these patients have not been established.AimsTo estimate the prevalence of polyuria associated with the use of lithium and to identify additional risk factors.MethodA 4-month prospective follow-up study in an out-patient lithium clinic. The 75 participants were asked to provide 24-h urine samples; polyuria was defined as a urine volume greater than 3 litres per 24 h. Risk factors examined included demographic variables, medications and medical comorbidities.ResultsThe prevalence of polyuria among lithium users was 37%. Concomitant use of serotonergic antidepressants was strongly associated with polyuria (odds ratio 4.25, 95% CI 1.15–15.68) compared with patients not using these agents.ConclusionsOur data confirm the high prevalence of lithium-induced polyuria. Physicians should be aware that concurrent use of serotonergic antidepressants and lithium significantly enhances the risk of its occurrence. Although limited polyuria is not harmful, it may be troublesome for the patient. In many cases cessation of lithium therapy is not an option because of difficulty in controlling the manic or depressive symptoms.
Adolescent precursors of cannabis dependence: findings from the Victorian Adolescent Health Cohort Study
Authors: Coffey Carolyn , Carlin John B. , Lynskey Michael , Li Ning , Patton George C. 
Published: April 2003

BackgroundDependence increases the likelihood of adverse consequences of cannabis use, but its aetiology is poorly understood.AimsTo examine adolescent precursors of young-adult cannabis dependence.MethodPutative risk factors were measured in a representative sample (n=2032) of secondary students in the State of Victoria, Australia, six times between 1992 and 1995. Cannabis dependence was assessed in 1998, at age 20–21 years.ResultsOf 1601 young adults, 115 met criteria for cannabis dependence. Male gender (OR=2.6, P < 0.01), regular cannabis use (weekly: OR=4.9; daily: OR=4.6, P=0.02), persistent antisocial behaviour (linear effect P=0.03) and persistent cigarette smoking (linear effect P=0.02) independently predicted cannabis dependence. Neither smoking severity (P=0.83) nor persistent psychiatric morbidity (linear effect P=0.26) independently predicted dependence. Regular cannabis use increased risk only in the absence of persistent problematic alcohol use.ConclusionsWeekly cannabis use marks a threshold for increased risk of later dependence, with selection of cannabis in preference to alcohol possibly indicating an early addiction process.
Management of mental illness by the British Army
Authors: Neal Leigh A. , Kiernan Matthew , Hill David , Mcmanus Frank , Turner Mark A. 
Published: March 2003

BackgroundThe Ministry of Defence has its own hospital for soldiers requiring admission for mental health problems.AimsTo assess the efficiency of the army psychiatric hospital at restoring patients to full active duty. To assess whether a new military training and rehabilitation unit (MTRU) that emphasises military-skills training, improves outcome.MethodA 2-year, inception-cohort outcome study of hospital in-patients. A 12-month, case-matched, ‘before and after’ outcome study compared MTRU patients with hospital in-patients.ResultsI (hospital in-patients, n=309): at 2-year follow-up 67 (22%) were fully fit for active duty Military psychiatrists' success rate at predicting recovery to active duty was 27%. 2: the odds of a soldier in the MTRU cohort (n=35) returning to active duty were 14 times greater than for the hospital cohort (n=35). The odds of remaining in the army while unfit for active duty were 20 times less for the MTRU than for the hospital cohort.ConclusionsThe army hospital is inefficient at rehabilitation to active duty. The MTRU significantly increased the odds of returning to active duty and reduced the odds of remaining in the army while still unfit. These findings may be applicable to the emergency services.
Reducing psychiatric stigma and discrimination: evaluation of educational interventions in UK secondary schools
Authors: Pinfold Vanessa , Toulmin Hilary , Thornicroft Graham , Huxley Peter , Farmer Paul , Graham Tanya 
Published: April 2003

BackgroundThe persistent and disabling nature of psychiatric stigma has led to the establishment of global programmes to challenge the negative stereotypes and discriminatory responses that generate social disability but these initiatives are rarely evaluated.AimsTo assess the effectiveness of an intervention with young people aimed at increasing mental health literacy and challenging negative stereotypes associated with severe mental illness.MethodA total of 472 secondary school students attended two mental health awareness workshops and completed pre- and post-questionnaires detailing knowledge, attitudes and behavioural intentions.ResultsYoung people use an extensive vocabulary of 270 different words and phrases to describe people with mental health problems: most were derogatory terms. Mean positive attitude scores rose significantly from 1.2 at baseline to 2.8 at 1-week follow-up and 2.3 at a 6-month follow-up. Changes were most marked for female students and those reporting personal contact with people with mental illness.ConclusionsShort educational workshops can produce positive changes in participants' reported attitudes towards people with mental health problems.
Stereological quantitation in cerebella from people with schizophrenia
Authors: Andersen Birgitte Bo , Pakkenberg Bente 
Published: March 2003

BackgroundBehavioural and anatomical studies in schizophrenia have pointed to cerebellar involvement.AimsTo provide stereological estimations of volumes and cell number in the cerebella of people with schizophrenia and a control group using post-mortem material.MethodStereological methods were applied to cerebella taken from eight male patients with a DSM–III diagnosis of chronic schizophrenia with no neurological disorder (mean age 57.5 years) and ten male controls (mean age 56.2 years). The Cavalieri principle was used to provide estimates of volumes, the optical disector method to obtain estimates of the numerical density of Purkinje and granule cells, and a combination of the two to obtain estimates of total cell numbers in the cerebellum. The rotator method was applied to obtain estimates of mean Purkinje cell volume.ResultsNo global structural difference in major volumes, cell numbers or Purkinje cell volume was found between the groups.ConclusionsThe most frequently reported pathological finding in the cerebellum in schizophrenia is vermal atrophy, which was not found in this small group of heavily affected patients.