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MS2_1shot400

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more The authors tested the hypothesis that early physical abuse is associated with later externalizing behavior outcomes and that this relation is mediated by the intervening development of biased social information-processing patterns . They assessed 584 r and omly selected boys and girls from European American and African American background s for the lifetime experience of physical abuse through clinical interviews with mothers prior to the child 's matriculation in kindergarten . Early abuse increased the risk of teacher-rated externalizing outcomes in Grade s 3 and 4 by fourfold , and this effect could not be accounted for by confounded ecological or child factors . Abuse was associated with later processing patterns ( encoding errors , hostile attributional biases , accessing of aggressive responses , and positive evaluations of aggression ) , which , in turn , predicted later externalizing outcomes With more than 200,000 veterans incarcerated , a significant need exists for the development of technologies that help veterans with felony histories return to employment . This study evaluated the effect of three methods of vocational assistance on competitive employment over a 6 mo follow-up period : ( 1 ) basic vocational services , ( 2 ) self- study using a vocational manual design ed for formerly incarcerated veterans , and ( 3 ) a group led by vocational staff using the vocational manual . We evaluated 111 veterans for time to obtain and total time of competitive employment . The group format was expected to be superior to the self- study and the self- study superior to basic services . Findings indicated that the group format was associated with quicker employment and more total employment than the basic and self- study conditions . Limitations and directions for future refinement are discussed Compared 11 probationers with a history of psychiatric referral to a r and omly selected group of unemployed persons from the State Unemployment Office in a number of job interview assessment situations . The probationers were rated as less skillful and also rated themselves as less likely to obtain employment than did the control Ss . After this pretest , the probationers were assigned to one of two treatment groups in which either monetary incentives for job interviews were provided or a skills training program was initiated . Posttest scores indicated that the skills program was most effective in changing behavioral and cognitive responses . These results generalized during the follow-up period ; the skills training group obtained employment more frequently than did the incentive group . Implication s for training critical skill deficits are discussed in terms of a response acquisition model BACKGROUND The value of the individual placement and support ( IPS ) programme in helping people with severe mental illness gain open employment is unknown in Europe . Our aim was to assess the effectiveness of IPS , and to examine whether its effect is modified by local labour markets and welfare systems . METHODS 312 patients with severe mental illness were r and omly assigned in six European centres to receive IPS ( n=156 ) or vocational services ( n=156 ) . Patients were followed up for 18 months . The primary outcome was the difference between the proportions of people entering competitive employment in the two groups . The heterogeneity of IPS effectiveness was explored with prospect i ve meta-analyses to establish the effect of local welfare systems and labour markets . Analysis was by intention to treat . This study is registered with Clinical Trials.gov , with the number NCT00461318 . FINDINGS IPS was more effective than vocational services for every vocational outcome , with 85 ( 55 % ) patients assigned to IPS working for at least 1 day compared with 43 ( 28 % ) patients assigned to vocational services ( difference 26.9 % , 95 % CI 16.4 - 37.4 ) . Patients assigned to vocational services were significantly more likely to drop out of the service and to be readmitted to hospital than were those assigned to IPS ( drop-out 70 [ 45 % ] vs 20 [ 13 % ] ; difference -32.1 % [ 95 % CI -41.5 to -22.7 ] ; readmission 42 [ 31 % ] vs 28 [ 20 % ] ; difference -11.2 % [ -21.5 to -0.90 ] ) . Local unemployment rates accounted for a substantial amount of the heterogeneity in IPS effectiveness . INTERPRETATION Our demonstration of the effectiveness of IPS in widely differing labour market and welfare context s confirms this service to be an effective approach for vocational rehabilitation in mental health that deserves investment and further investigation Output:

Collectively they provided limited evidence that work skills programmes increase the likelihood of people with mental disorder who are offenders obtaining employment in the short term , but there are insufficient studies to determine the long-term impact of work skills programmes . There is modest evidence to support inclusion of specific work skills programmes in the treatment of offenders with mental disorder .

MS2_1shot401

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: OBJECTIVE To study and evaluate a sequential , extended embryo culture system . DESIGN Prospect i ve study . SETTING University-affiliated IVF clinic . PATIENT(S ) All couples who were treated between October 1997 and July 1998 . INTERVENTION(S ) A st and ard human tubal fluid plus 10 % serum substitute supplement ( SSS ) culture medium was used . The embryos were transferred to extended culture medium ( S2 or G2 ) on day 3 . MAIN OUTCOME MEASURE(S ) Blastocyst formation and implantation and pregnancy rates . RESULT ( S ) Forty percent of the 20 donated cryopreserved embryos progressed to the blastocyst stage by day 6 . Clinical ly , 7 ( 5.6 % ) of the 125 cycles did not result in a transfer . Blastocyst formation rates ranged from 33%-63 % in the five study groups . Implantation rates ranged from 15%-52 % and pregnancy rates ranged from 37%-75 % . CONCLUSION ( S ) Extended culture to day 5 or 6 results in acceptable blastocyst formation rates , implantation rates , and pregnancy rates The transfer of blastocysts has been associated with a very high implantation rate . However , not all embryos achieve the blastocyst stage . Our study was set up to demonstrate whether embryo morphology on day 3 predicts subsequent blastocyst formation . A prospect i ve study was carried out in 48 patients with a mean of 2.9 failed in-vitro fertilization ( IVF ) attempts . In this new cycle , the morphology of the embryos on day 3 was noted . After pre- selection of the embryos which would have been transferred on day 3 , all embryos were cultured individually and allowed to develop further until transfer on day 5 . The clinical pregnancy rate per transfer was 46 % , and the overall implantation rate was 24 % . When only blastocysts were transferred the pregnancy rate was 53 % with an implantation rate of 30 % . Thirty-nine per cent of all embryos reached the blastocyst stage on day 5 ; 47 % of class 1 and 2 embryos ( good quality ) in contrast to 21 % of class 3 and 4 embryos ( poor quality ) . Respectively 45 % of class 1 and 2 embryos and 69 % of class 3 and 4 embryos arrested in development or degenerated . Only 51 % of the embryos that were transferred on day 5 had been pre-selected for transfer on day 3 . In conclusion , it appears that the predictive value of embryo morphology on day 3 for subsequent blastocyst formation is limited Results of french multiple collaborative studies are reported to evaluate the possible benefits of coculture in human IVF program . Prospect i ve r and omized study of IVF with transfer on day two versus IVF with transfer on day 6 shows that coculture does not improve overall results but leads to a reduction of triple or quadruple pregnancies . When applied to patients with more than 4 failures of embryo transfers on day 2 , delayed transfer of blastocyst results in a high rate of clinical pregnancy ( 39 % ) . Transfers of frozen-thawed blastocysts result in 17.8 % ongoing pregnancies . Coculture is also a powerful tool for underst and ing early embryo development : when fertilization arises from sperm with poor characteristics or from frozen sperm of donor , embryo development appears to be altered : in these situations , rate of normally developing embryo is reduced and early embryo development becomes independent of fertilization rate BACKGROUND The aim of this study was to compare ongoing pregnancy rates per started cycle between patients r and omized at consultation to have embryo transfer either on day 3 or on day 5 of in-vitro culture . METHODS All patients < 43 years of age for whom IVF was indicated were allowed to participate in the study ( day 3 group , 234 patients ; day 5 group , 226 patients ) . Ovarian stimulation was performed either using GnRH antagonists/recombinant FSH ( rFSH ) ( day 3 , 70.1 % of patients ; day 5 , 72.6 % of patients ) or using the long GnRH agonist protocol /urinary gonadotropins ( day 3 , 29.9 % of patients ; day 5 27.4 % of patients ) . RESULTS The r and om decision to initiate a cycle leading to day 5 as compared with a day 3 transfer was associated with a significantly lower chance of embryo cryopreservation ( day 3 , 61.5 % ; day 5 , 50.4 % ; P<0.02 ) . Ongoing pregnancy rate per started cycle did not differ between the two groups compared [ day 3 , 32.1 % , 95 % confidence interval ( CI ) 26.4 - 38.2 % ; day 5 , 33.2 % , 95 % CI 27.3 - 39.5 % ] . CONCLUSIONS Advising patients at consultation to initiate an IVF cycle leading to a day 5 as compared with a day 3 transfer does not appear to increase the probability of ongoing pregnancy , and is associated with a significantly lower probability of obtaining cryopreserved embryos It is believed that delayed transfer of embryos after IVF allows for a better selection of good quality embryos . Hence , the number of embryos and all other prognostic factors being equal , transfer of day 3 embryos should be associated with higher implantation and pregnancy rates than transfer of day 2 embryos . To investigate this hypothesis , a prospect i ve r and omized study was carried out to compare implantation and pregnancy rates between day 2 and day 3 transfers . The relationship between the embryo quality score of day 2 and day 3 embryos and their respective implantation rates was also analysed . In a 2 year period all patients undergoing infertility treatment and in whom at least seven normally fertilized oocytes were obtained were included in the study . A minimization procedure was performed taking into account the patient 's age and the method of fertilization ( IVF or intracytoplasmic sperm injection ) . By using a uniform policy of embryo transfer , the number of embryos transferred was similar in both groups . The outcome parameters were embryo quality , implantation and pregnancy rates . No difference was observed in implantation and pregnancy rates between transfers on day 2 versus day 3 ( 23.8 versus 23.8 % and 47.9 versus 46.8 % respectively ) . The incidence of embryos of moderate to poor quality was higher in embryos cultured for 3 days compared with those cultured for 2 days . It is concluded that the outcomes of embryo transfer in terms of implantation and pregnancy rates are comparable for day 2 and day 3 embryos , although the overall embryo quality score decreases when embryos are kept in culture till day 3 BACKGROUND It is generally accepted that the age-related increased aneuploidy rate is correlated with reduced implantation and a higher abortion rate . Therefore , advanced maternal age ( AMA ) couples are a good target group to assess the possible benefit of preimplantation genetic diagnosis for aneuploidy screening ( PGD-AS ) on the outcome after assisted reproductive technology ( ART ) . METHODS A prospect i ve r and omized controlled clinical trial ( RCT ) was carried out comparing the outcome after blastocyst transfer combined with PGD-AS using fluorescence in situ hybridization ( FISH ) for the chromosomes X , Y , 13 , 16 , 18 , 21 and 22 in AMA couples ( aged > or = 37 years ) with a control group without PGD-AS . From the 400 ( 200 for PGD-AS and 200 controls ) couples that were allocated to the trial , an oocyte pick-up was performed effectively in 289 cycles ( 148 PGD-AS cycles and 141 control cycles ) . RESULTS Positive serum HCG rates per transfer and per cycle were the same for PGD-AS and controls : 35.8 % ( 19.6 % ) [ % /per embryo transfer ( per cycle ) ] and 32.2 % ( 27.7 % ) , respectively ( NS ) . Significantly fewer embryos were transferred in the PGD-AS group than in the control group ( P<0.001 ) . The implantation rate ( with fetal heart beat ) was 17.1 % in the PGD-AS group versus 11.5 % in the control group ( not significant ; P=0.09 ) . We observed a normal diploid status in 36.8 % of the embryos . CONCLUSIONS This RCT provides no arguments in favour of PGD-AS for improving clinical outcome per initiated cycle in patients with AMA when there are no restrictions in the number of embryos to be transferred Preliminary results are presented concerning the first clinical application of cocultures of human embryos . In the experimental group , the embryos were cultured and transferred on day 5 post-insemination . Blastocyst formation was not dependent upon the stimulation regimen . Long term or ultrashort stimulation of the ovaries after gonadotrophin releasing hormone analogue gave 55 - 60 % blastocyst formation . Serum was not necessary to obtain blastocysts . When the embryos were cocultured , we observed an increase in the implantation rates per embryo in the pregnant patients . However , a real increase in the pregnancy rate per transfer was observed in a population of patients who had had repeated failures of embryo transfer . This observation is discussed as possibly bypassing an effect of uterine motility , but the overall beneficial effect has to be assessed in a double blind r and omized study . It is probable that improvements will not be observed for all the indications for in vitro fertilization OBJECTIVE To analyze the birth weights and sex ratio of infants born after blastocyst transfer . DESIGN Retrospective analysis . SETTING Three infertility clinics . PATIENT(S ) Patients admitted for IVF with blastocyst transfer . INTERVENTION None . MAIN OUTCOME MEASURE(S ) Birth weights and sex ratio of infants born after blastocyst transfer . RESULT ( S ) Statistically significantly more male infants were born after transfer of fresh blastocysts , either cocultured or cultured in sequential media . No specific differences in birth weight were observed between infants born after blastocyst transfer and those born after spontaneous conception . CONCLUSION ( S ) More male infants than female infants were born after blastocyst transfer when transfers were performed as soon as the blastocyst stage was reached and male embryos had a faster cleavage rate BACKGROUND Recently , advances in human IVF-embryo transfer ( ET ) have been reported using sequential media and blastocyst stage ET . In our previous report , using a prospect i ve , r and omized study , no advantage was found using the blastocyst stage ET compared with day 3 ET . This study was performed in order to evaluate implantation and pregnancy rates of hatching blastocyst stage ET compared with conventional day 3 ET . METHODS AND RESULTS A total of 480 patient cycles were evaluated using a prospect i ve , r and omized study . The pregnancy rate and implantation rate were compared between the day 3 ET ( n = 240 ) and hatching blastocyst stage ET ( Hat ET ; n = 240 ) . The Hat ET group had a pregnancy rate of 29.3 % ( 55 out of 188 ) and an implantation rate of 21.4 % ( 67 out of 313 ) . The day 3 ET group had a pregnancy rate of 29.2 % ( 70 out of 240 ) and an implantation rate of 19.1 % ( 93 out of 488 ) . In the Hat ET group , the pregnancy rate , implantation rate and ongoing pregnancy rate of day 5 ET and day 6 ET were all higher than the respective rates in the day 7 - 9 ET group . CONCLUSION We found that the pregnancy rate and implantation rate of ET with hatching stage blastocysts had no advantage compared with the conventional day 3 ET OBJECTIVE : To evaluate the efficacy of blastocyst transfer in comparison with cleavage stage transfer . STUDY DESIGN : A r and omized , prospect i ve study was conducted in Infertility clinic , Department of Obstetrics and Gynecology , Mahatma G and hi Hospital , Jaipur on 300 patients aged 25 - 40 years undergoing in-vitro fertilization (IVF)/intra-cytoplasmic sperm injection ( ICSI ) cycle from May 2010-April 2011 . When three or more Grade -I embryos were observed on day 2 of culture , patients were divided r and omly into two study groups , cleavage stage transfer and blastocyst transfer group having 150 patients each . Primary outcomes evaluated were , Clinical pregnancy rate and Implantation rate . The results were analyzed using proportions , st and ard deviation and Chi-square test . RESULTS : Both the groups were similar for age , indication and number of embryos transferred . Clinical pregnancies after blastocyst transfer were significantly higher 66 ( 44.0 % ) compared to cleavage stage embryo transfer 44 ( 29.33 % ) ( P < 0.01 ) . Implantation rate for blastocyst transfer group was also significantly higher ( P < 0.001 ) . CONCLUSION : Blastocyst transfer having higher implantation rate and clinical pregnancy rate lead to reduction in multiple pregnancies OBJECTIVE To compare blastocyst-stage embryo Output:

There is low quality evidence for live birth and moderate quality evidence for clinical pregnancy that fresh blastocyst stage transfer is associated with higher rates than fresh cleavage stage transfer . There was no evidence of a difference between the groups in cumulative pregnancy rates derived from fresh and frozen-thawed cycles following a single oocyte retrieval , but the evidence for this outcome was very low quality . Thus , although there is a benefit favouring blastocyst transfer in fresh cycles , it remains unclear whether the day of transfer impacts on cumulative live birth and pregnancy rates .

MS2_1shot402

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Bariatric surgery is the most effective long term weight-loss therapy for severe and morbidly obese patients . Melanocortin-4 Receptor ( MC4R ) mutations , the most frequent known cause of monogenic obesity , affect the regulation of energy homeostasis . The impact of such mutations on weight loss after bariatric surgery is still debated . The objective is to determine the impact of MC4R status on weight loss in obese subjects over one year after bariatric surgery . A total of 648 patients , who were referred to bariatric surgery in a single clinical nutrition department , were genotyped for their MC4R status . The following four groups were categorized : functional MC4R mutations , MC4R single nucleotide polymorphisms ( SNPs ) : Val103Ile ( V103L ) and Ile251Leu ( I251L ) , MC4R variant rs17782313 ( downstream of MC4R ) and MC4R SNP A-178C on the promoter . Each patient was matched with two r and omly paired controls without mutation . Matching factors were age , sex , baseline weight and type of surgery procedure ( Roux-en-Y gastric bypass and adjustable gastric b and ing ) . We compared weight loss between cases and controls at 3 , 6 and 12 months after surgery . Among 648 patients , we identified 9 carriers of functional MC4R mutations , 10 carriers of MC4R V103L and I251L SNPs , 7 carriers of the rs17792313 variant and 22 carriers of the A-178C SNP . Weight loss at 3 , 6 and 12 months did not differ between cases and controls , whatever the MC4R mutations . This is the first case-control study to show that MC4R mutations and polymorphisms do not affect weight loss and body composition over one year after bariatric surgery Context Some experts attribute a low incidence of heart disease in Mediterranean countries to dietary habits . Contribution In this multicenter , 3-group trial , investigators r and omly assigned 772 adults at high risk for cardiovascular disease to a low-fat diet or to a Mediterranean diet supplemented with either virgin olive oil ( 1 L per week ) or nuts ( 30 g per day ) . After 3 months , the Mediterranean diet groups had lower mean plasma glucose level , systolic blood pressure , and total cholesterolhigh-density lipoprotein cholesterol ratio than the low-fat diet group . Caution s The Mediterranean diet groups received more nutritional education than the low-fat diet group . Implication s Mediterranean diets supplemented with olive oil or nuts may improve cardiovascular risk factors . The Editors Cardiovascular disease is the main cause of death in industrialized countries , but incidence rates have marked geographic differences . The low incidence of coronary heart disease ( CHD ) in Mediterranean countries has been partly ascribed to dietary habits ( 1 - 3 ) . Recent findings from large European cohort studies ( 4 - 6 ) suggest that a high degree of adherence to the Mediterranean diet is associated with a reduction in mortality . In small clinical studies , the Mediterranean diet or some of its components have reduced blood pressure ( 7 ) and have improved lipid profiles ( 8 , 9 ) and endothelial function ( 10 ) . Moreover , a recent cross-sectional study ( 11 ) and a 2-year feeding trial ( 12 ) have shown that adherence to the Mediterranean diet is associated with reduced markers of vascular inflammation . These beneficial effects on surrogate markers of cardiovascular risk add biological plausibility to the epidemiologic evidence that supports a protective effect of the Mediterranean diet . Olive oil , a rich source of monounsaturated fatty acids , is a main component of the Mediterranean diet . Virgin olive oil retains all the lipophilic components of the fruit , -tocopherol , and phenolic compounds with strong antioxidant and anti-inflammatory properties ( 13 , 14 ) . Tree nuts , which are also typical in the Mediterranean diet , have a favorable fatty acid profile and are a rich source of nutrients and other bioactive compounds that may beneficially influence the risk for CHD , such as fiber , phytosterols , folic acid , and antioxidants ( 15 ) . Frequent nut intake has been associated with decreased CHD rates in prospect i ve studies ( 15 ) . Walnuts differ from all other nuts through their high content of polyunsaturated fatty acids , particularly -linolenic acid , a plant n-3 fatty acid ( 16 ) , which may confer additional antiatherogenic properties ( 17 ) . Therefore , we design ed a large-scale feeding trial in high-risk participants to assess the effects of 2 Mediterranean diets , one supplemented with virgin olive oil and the other supplemented with mixed nuts , compared with a low-fat diet on cardiovascular outcomes . We report the results of a 3-month intervention on intermediate markers of cardiovascular risk in the first 772 participants who were recruited into the trial . Supplement . Original Version ( PDF ) Methods Study Design The Prevencin con Dieta Mediterrnea ( PREDIMED ) Study is a large , parallel-group , multicenter , r and omized , controlled , 4-year clinical trial that aims to assess the effects of the Mediterranean diet on the primary prevention of cardiovascular disease ( www.predimed.org ) . An estimated 9000 high-risk participants ( > 5000 participants are already recruited ) will be assigned to 3 interventions : Mediterranean diet with virgin olive oil , Mediterranean diet with mixed nuts , or low-fat diet . The main outcome is an aggregate of cardiovascular events ( cardiovascular death , nonfatal myocardial infa rct ion , or nonfatal stroke ) . The anticipated completion date of the trial is December 2010 . We design ed our present study to assess the 3-month effects of the dietary interventions on surrogate markers of cardiovascular risk in participants entering the study during the first 6 months of recruitment . The institutional review boards of the 10 participating centers approved the study protocol . Participants and Recruitment From October 2003 to March 2004 , we selected 930 potential participants in primary care centers affiliated with 10 teaching hospitals across Spain . Eligible participants were community-dwelling men , 55 to 80 years of age , and women , 60 to 80 years of age , who fulfilled at least 1 of 2 criteria : type 2 diabetes or 3 or more CHD risk factors ( current smoking , hypertension [ blood pressure > 140/90 mm Hg or treatment with antihypertensive drugs ] , low-density lipoprotein [ LDL ] cholesterol level 4.14 mmol/L [ 160 mg/dL ] [ or treatment with hypolipidemic drugs ] , high-density lipoprotein [ HDL ] cholesterol level 1.04 mmol/L [ 40 mg/dL ] , body mass index [ BMI ] 25 kg/m2 , or a family history of premature CHD ) . Exclusion criteria were history of cardiovascular disease , any severe chronic illness , drug or alcohol addiction , history of allergy or intolerance to olive oil or nuts , or low predicted likelihood of changing dietary habits according to the stages-of-change model ( 18 ) . The primary care physicians based participants ' eligibility on review of clinical records and a screening visit . They obtained a list of c and i date s from computer-based records of patients who attended each participating center and review ed their clinical records to exclude those who did not meet eligibility criteria . They then invited suitable c and i date s by telephone to attend a screening visit . The visit included an interview with administration of a 26-item question naire to inquire about medical conditions and risk factors related to eligibility . Of the eligible c and i date s who met entry requirements , 95 % agreed to participate and provided informed consent . R and omization and Intervention After the screening visit , each center r and omly assigned eligible participants to 1 of 3 diet groups by using a computer-generated r and om-number sequence . The coordinating center constructed the r and omization table , and participants were r and omly assigned into blocks of 50 participants balanced by center , sex , and age group ( < 70 years and 70 years ) . We concealed allocation into the intervention groups by using closed envelopes with correlative numbers by prespecified subgroups of sex and age . The baseline examination included the administration of a 14-item question naire , an extension of a previously vali date d question naire ( 19 ) , that assessed the degree of adherence to the traditional Mediterranean diet . We assigned values of 0 or 1 to each item ( Appendix Table 1 ) . We also administered a 137-item vali date d food frequency question naire ( 20 ) ; the vali date d Spanish version ( 21 ) of the Minnesota Leisure Time Physical Activity Question naire ; and a 47-item question naire about education , lifestyle , history of illnesses , and medication use . We performed anthropometric and blood pressure measurements and obtained sample s of fasting blood and spot urine . We repeated all examinations at 3 months . The same dietitian delivered the interventions to the 3 r and omized groups in each center . On the basis of the assessment of individual Mediterranean diet scores , the dietitian gave personalized dietary advice during a 30-minute session to each participant , with recommendations on the desired frequency of intake of specific foods . We advised participants who were allocated to the low-fat diet to reduce intake of all types of fat , and we gave them a leaflet with written recommendations according to the American Heart Association guidelines ( 22 ) . For total fat intake , these recommendations were opposite to those given to participants in the 2 Mediterranean diet groups , who received instructions intended to increase the 14-item Mediterranean diet score , including increased consumption of vegetable fats and oils . We did not suggest any energy restriction . While the participants who were allocated to the low-fat diet did not receive further intervention , those assigned the 2 Mediterranean diet groups had access to more intense intervention in 2 ways . First , they were given a free provision of typical Mediterranean fatty foods ( olive oil or nuts ) . Depending on group assignment , participants were given either free virgin olive oil ( 15 L [ 1 L/wk ] for 3 months ) or free sachets of walnuts , hazelnuts , and almonds ( 1350 g of walnuts [ 15 g/d ] , 675 g of hazelnuts [ 7.5 g/d ] , and 675 g of almonds [ 7.5 g/d ] for 3 months ) . To improve adherence and account for family needs , participants in the corresponding Mediterranean diet groups were given excess olive oil or additional 1000-g packets of nuts . We analyzed the nutrient composition of the olive oil and nuts used in the study by st and ard methods in a reference laboratory ( Appendix Table 2 ) ) . Second , 1 week after inclusion , the dietitian delivered a 1-hour group session with up to 20 participants , with separate sessions for each Mediterranean diet group . Each group session consisted of informative talks and provision of written material s with elaborate descriptions of typical Mediterranean foods and seasonal shopping lists , meal plans , and cooking recipes . Throughout the study , all participants had free and continuous access to their center dietitian for advice and consultation . Measurements Trained personnel measured weight and height by using calibrated scales and a wall-mounted stadiometer , respectively ; waist circumference midway between the lowest rib and the iliac crest by using an anthropometric tape ; and blood pressure in triplicate with a vali date d semiautomatic oscillometer ( Omron HEM-705CP , Hoofddorp , the Netherl and s ) . We calculated energy and nutrient intake from Spanish food composition tables ( 23 ) . At the 3-month visit and when consulted by participants , dietitians assessed any adverse effects from the interventions by administering a checklist of symptoms and gave advice on how to remedy them . The checklist included mouth symptoms ; bloating , fullness , or indigestion ; altered bowel Cigarette smoking impairs endothelial function and is one of the major risk factors for atherosclerosis and coronary heart disease . Insulin resistance is associated with major risk factors for atherosclerosis . We examined the effects of vitamin C on insulin sensitivity and endothelial function by measuring steady-state plasma glucose ( SSPG ) and flow-mediated dilation ( FMD ) of the brachial artery . We studied 16 current smokers with normal glucose tolerance , 15 nonsmokers with impaired glucose tolerance ( IGT ) , and 17 nonsmokers with normal glucose tolerance as controls . Both SSPG and FMD were blunted in smokers and nonsmokers with IGT compared with controls . In smokers , vitamin C decreased SSPG ( P < 0.01 by ANOVA ) with decreasing plasma thiobarbituric acid-reactive substances ( TBARS ) ( P < 0.05 by ANOVA ) and improved FMD ( P < 0.05 by ANOVA ) . Furthermore , vitamin C improved both SSPG ( P < 0.005 by ANOVA ) and FMD ( P < 0.05 by ANOVA ) in nonsmokers with IGT . SSPG , FMD , or TBARS in controls did not change after vitamin C infusion . There was a significant correlation between Output:

Consumption of highly salty foods and adherence to a Mediterranean dietary pattern can modulate the association between MC4R polymorphisms and the risk of obesity or Type 2 diabetes . Despite the highly contradictory results of intervention studies , after short-term lifestyle interventions , children with variant alleles of MC4R single nucleotide polymorphisms can lose more body weight , compared with non-carriers , although they may have difficulty in maintaining this weight loss in the long-term . The interaction between MC4R genes with dietary factors plays a significant role in the development of obesity or Type 2 diabetes phenotypes .

MS2_1shot403

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Little is known about the long-term benefits of interventions that aim to promote early childhood development programs . The goal of this research was to determine whether an early childhood development intervention added to a nutrition intervention during preschool ages had lasting effects on the cognitive development of school-age children in communes of Thanh Hoa province in rural Vietnam . The study focused on a total of 313 children aged 6.5 - 8.5 y ( grade s 1 and 2 in primary school ) in 2 communes that were exposed to nutrition intervention or nutrition and early childhood development ( ECD ) intervention from 1999 to 2003 . Measurements of height and cognitive test scores ( Raven 's Progressive Matrices Test ) were collected from the children ; household characteristics were determined by interviews with mothers . Longitudinal analysis was performed by integrating the data with that collected from the same children in past surveys . Significant effects of the ECD intervention compared with the nutrition intervention were detected . The beneficial effect of ECD intervention on the cognitive test scores was large for the most nutritionally challenged children whose height-for-age Z-scores declined or remained in the stunted range . The findings help provide useful insights into the development of an effective integrated model of ECD and nutrition intervention for children in rural Vietnam The Cali Study involved the r and om assignment of 301 malnourished children to be exposed to one ( CT1 , n = 113 ) , two ( CT2 , n = 64 ) , three ( CT3 , n = 62 ) or four ( CT4 , n = 62 ) 9-mo periods of a multifocal day care-based intervention ( i.e. , education , health and nutrition ) . The ages at which the intervention was initiated for Groups CT4 , CT3 , CT2 and CT1 were 3.5 , 4.2 , 5.2 and 6.1 y , respectively . After the experimental phase , children were followed up in elementary school until they were 10.4 y old . Our secondary data analyses show that children who were exposed at an earlier age and for a longer period of time showed the highest degree ( P < or = 0.05 ) of improvement in weight and linear growth during the pre-school period . These improvements in physical growth could no longer be detected 3 y after the termination of the intervention OBJECTIVES We examined ( 1 ) whether attending out-of-home day care centres ( DCCs ) has differential effects on improvement of child nutrition and facilitation of maternal employment depending on availability of non-institutionalised childcare support and ( 2 ) whether attendance increases infectious diseases . METHODS In a prospect i ve before-after comparison study at public DCCs in Pokhara , Nepal , we compared weight-for-age Z-score ( WAZ ) and height-for-age Z-score ( HAZ ) among children attending DCCs between at admission , after 6 months , and after 1 year and determined differential changes in these measures between those with and without appropriate childcare support . We used repeated measures analysis of variance with interaction terms between support availability and DCC attendance . We compared maternal income and incidence of diarrhoea and fever in children between the periods of waiting and attending . RESULTS After 6 months , neither WAZ nor HAZ significantly changed . After 1 year , WAZ significantly improved , but HAZ did not change among all participants . Those without appropriate childcare support showed greater improvement in both WAZ and HAZ than those with support . While children were attending , income increased only among those mothers who were already working without any childcare support at baseline . Neither diarrhoea nor fever increased . CONCLUSIONS DCCs can be more beneficial for child nutrition and working mothers in households lacking childcare support than in those with support In the Abecedarian Project , a prospect i ve r and omized trial , the effects of early educational intervention on patterns of cognitive and academic development among poor , minority children were examined . Participants in the follow-up were 104 of the original 111 participants in the study ( 98 % African American ) . Early treatment was full-time , high- quality , educational child care from infancy to age 5 . Cognitive test scores collected between the ages of 3 and 21 years and academic test scores from 8 to 21 years were analyzed . Treated children , on average , attained higher scores on both cognitive and academic tests , with moderate to large treatment effect sizes observed through age 21 . Preschool cognitive gains accounted for a substantial portion of treatment differences in the development of reading and math skills . Intensive early childhood education can have long-lasting effects on cognitive and academic development Background This paper presents the study protocol for a pragmatic cluster r and omized controlled trial ( RCT ) with a supplementary matched control group . The aim of the trial is to evaluate a community-based early education and development program launched by the Government of Indonesia . The program was developed in collaboration with the World Bank with a total budget of US$ 127.7 million , and targets an estimated 738,000 children aged 0 to 6 years living in approximately 6,000 poor communities . The aim of the program is to increase access to early childhood services with the secondary aim of improving school readiness . Methods / Design The study is being conducted across nine districts . The baseline survey contained 310 villages , of which 100 were originally allocated to the intervention arm , 20 originally allocated to a 9-month delay staggered start , 100 originally allocated to an 18-month delay staggered start and 90 allocated to a matched control group ( no intervention ) . The study consists of two cohorts , one comprising children aged 12 to 23 months and the other comprising children aged 48 to 59 months at baseline . The data collection instruments include child observations and task/game-based assessment s as well as a question naire suite , village head question naire , service level question naires , household question naire , and child caretaker question naire . The baseline survey was conducted from March to April 2009 , midline was conducted from April to August 2010 and endline conducted early 2013 . The result ant participation rates at both the district and village levels were 90 % . At the child level , the participation rate was 99.92 % . The retention rate at the child level at midline was 99.67 % . Discussion This protocol paper provides a detailed record of the trial design including a discussion regarding difficulties faced with compliance to the r and omization , compliance to the dispersion schedule of community block grants , and procurement delays for baseline and midline data collection s. Considering the execution of the program and the result ant threats to the study , we discuss our analytical plan and intentions for endline data collection .Trials registration Current Controlled Trials IS RCT Abstract Objective : To measure the effects of iron supplementation and anthelmintic treatment on iron status , anaemia , growth , morbidity , and development of children aged 6–59 months . Design : Double blind , placebo controlled r and omised factorial trial of iron supplementation and anthelmintic treatment . Setting : Community in Pemba Isl and , Zanzibar . Participants : 614 preschool children aged 6–59 months . Main outcome measures : Development of language and motor skills assessed by parental interview before and after treatment in age appropriate subgroups . Results : Before intervention , anaemia was prevalent and severe , and geohelminth infections were prevalent and light — Plasmodium falciparum infection was nearly universal . Iron supplementation significantly improved iron status , but not haemoglobin status . Iron supplementation improved language development by 0.8 ( 95 % confidence interval 0.2 to 1.4 ) points on the 20 point scale . Iron supplementation also improved motor development , but this effect was modified by baseline haemoglobin concentrations ( P=0.015 for interaction term ) and was apparent only in children with baseline haemoglobin concentrations < 90 g/l . In children with a baseline haemoglobin concentration of 68 g/l ( one st and ard deviation below the mean value ) , iron treatment increased scores by 1.1 ( 0.1 to 2.1 ) points on the 18 point motor scale . Mebendazole significantly reduced the number and severity of infections caused by Ascaris lumbricoides and Trichuris trichiura , but not by hookworms . Mebendazole increased development scores by 0.4 ( −0.3 to 1.1 ) points on the motor scale and 0.3 ( −0.3 to 0.9 ) points on the language scale . Conclusions : Iron supplementation improved motor and language development of preschool children in rural Africa . The effects of iron on motor development were limited to children with more severe anaemia ( baseline haemoglobin concentration < 90 g/l ) . Mebendazole had a positive effect on motor and language development , but this was not statistically significant . What is already known on this topic Iron is needed for development and functioning of the human brain Anaemic children show developmental delays , but it is not yet clear whether iron deficiency causes these deficits or whether iron supplementation can reverse them Helminth infections in schoolchildren are associated with cognitive deficits , but few studies have been made of helminth infection and early child development What this study adds Low doses of oral iron supplementation given daily improved language development in children aged 1–4 years in Zanzibar Iron supplementation improved motor development , but only in children with initial haemoglobin concentrations below 90 g/l The effects of routine anthelmintic treatment on motor and language milestones were positive , but non-significant , with our sample To determine the risk for diarrheal disease ( DD ) in day-care centers ( DCC ) for children residing in a poor urban slum area of Quito , Ecuador , compared with that for children from the same environment but cared for in their own residential home ( RH ) , a prospect i ve age- , sex- and locale-controlled study of DD was conducted , including 115 children in DCC and 115 in RH , ages 12 to 42 months . The overall incidence of DD was 46/1000 child weeks . Diarrhea was more common in DCC than in RH ( relative risk ( RR ) , 1.75 ; 95 % confidence interval ( CI ) , 1.38 to 2.22 ; P < 0.001 ) . Poor hygienic practice s were more prevalent in DCC than in RH . The use of reused water for child h and washing before eating and for washing raw vegetables was associated with a higher risk of DD in DCC than in RH ( RR = 4.08 , CI 2.93 to 5.67 , P < 0.001 ; RR = 3.90 , CI 2.79 to 5.44 , P < 0.001 , respectively ) . These two practice s were risk factors in the DCC ( RR = 2.74 , CI 2.08 to 3.68 , P < 0.001 ; RR = 2.05 , CI 1.55 to 2.71 , P < 0.001 , respectively ) when compared with their absence in the same DCC . Shigella ( RR = 3.58 , CI 1.19 to 10.78 , P < 0.02 ) , Aeromonas ( RR = 10.47 , CI 1.35 to 81.05 , P < 0.01 ) , rotavirus ( RR = 2.86 , CI 1.87 to 4.39 , P < 0.001 ) and Giardia ( RR = 1.59 , CI 1.00 to 2.59 , P < 0.05 ) were more common in DCC than in RH . More than two-fifths of the Shigella and Aeromonas isolates were resistant to trimethoprim-sulfamethoxazole . ( ABSTRACT TRUNCATED AT 250 WORDS OBJECTIVE Methods to prevent two major mental disorders , schizophrenia and conduct disorder , have been elusive . This study assessed the effects of an early nutritional , educational , and physical exercise enrichment program on adult outcome for schizotypal personality , conduct disorder , and criminal behavior . METHOD Eighty-three children were assigned to an experimental enrichment program from ages 3 to 5 years and matched on temperament , nutritional , cognitive , autonomic , and demographic variables with 355 children who experienced usual community conditions ( control group ) . Both self-report and objective measures of schizotypal personality and antisocial behavior were obtained when the subjects were ages 17 and 23 years . RESULTS Subjects who participated in the enrichment program at ages 3 - 5 years had lower scores for schizotypal personality and antisocial behavior at age 17 years and for criminal behavior at age 23 years , compared with the control subjects . The beneficial effects of the intervention were greater for children who showed signs of malnutrition at age 3 years , particularly with respect to outcomes for schizotypy at ages 17 and 23 and for antisocial behavior at age 17 . CONCLUSIONS The results are consistent with an increasing body of knowledge that implicates an enriched , stimulating environment in beneficial psychological and behavioral outcomes . These findings have potential implication s for the prevention of schizophrenia and criminal behavior BACKGROUND School-based interventions involving teacher and /or child training have been shown to benefit teacher practice s and to prevent conduct problems and improve children 's social and emotional competence in developed countries ; however , we are aware of no reports from a developing country . We conducted a pilot study of the Incredible Years Teacher Training programme and a curriculum unit on social and emotional skills based on concepts and activities drawn from the Incredible Years Dina Dinosaur Classroom Curriculum to determine if this approach is appropriate for use with Jamaican pre-school teachers and children . METHODS Five pre-schools in Kingston , Jamaica were r and omly assigned to an intervention ( 3 pre-schools with 15 classrooms ) or control ( 2 pre-sch Output:

The single study included in this review provides limited evidence on the effects of centre-based day care for children younger than five years of age in low- and middle-income countries .

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***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: The optimal strategy to achieve palliation of malignant pleural effusions ( MPEs ) is unknown . This multi-institutional , prospect i ve , r and omized trial compares 2 established methods for controlling symptomatic unilateral MPEs . Patients with unilateral MPEs were r and omized to either daily tunneled catheter drainage ( TCD ) or bedside talc pleurodesis ( TP ) . This trial is patterned after a previous r and omized trial that showed that bedside TP was equivalent to thoracoscopic TP ( CALGB 9334 ) . The primary end point of the current study was combined success : consistent/reliable drainage/pleurodesis , lung expansion , and 30-day survival . A secondary end point , survival with effusion control , was added retrospectively . This trial r and omized 57 patients who were similar in terms of age ( 62 years ) , active chemotherapy ( 28 % ) , and histologic diagnosis ( lung , 63 % ; breast , 12 % ; other/unknown cancers , 25 % ) to either bedside TP or TCD . Combined success was higher with TCD ( 62 % ) than with TP ( 46 % ; odds ratio , 5.0 ; P = .064 ) . Multivariate regression analysis revealed that patients treated with TCD had better 30-day activity without dyspnea scores ( 8.7 vs. 5.9 ; P = .036 ) , especially in the subgroup with impaired expansion ( 9.1 vs. 4.6 ; P = .042 ) . Patients who underwent TCD had better survival with effusion control at 30 days compared with those who underwent TP ( 82 % vs. 52 % , respectively ; P = .024 ) . In this prospect i ve r and omized trial , TCD achieved superior palliation of unilateral MPEs than TP , particularly in patients with trapped lungs IMPORTANCE For treatment of malignant pleural effusion , nonsteroidal anti-inflammatory drugs ( NSAIDs ) are avoided because they may reduce pleurodesis efficacy . Smaller chest tubes may be less painful than larger tubes , but efficacy in pleurodesis has not been proven . OBJECTIVE To assess the effect of chest tube size and analgesia ( NSAIDs vs opiates ) on pain and clinical efficacy related to pleurodesis in patients with malignant pleural effusion . DESIGN , SETTING , AND PARTICIPANTS A 2 × 2 factorial phase 3 r and omized clinical trial among 320 patients requiring pleurodesis in 16 UK hospitals from 2007 to 2013 . INTERVENTIONS Patients undergoing thoracoscopy ( n = 206 ; clinical decision if biopsy was required ) received a 24F chest tube and were r and omized to receive opiates ( n = 103 ) vs NSAIDs ( n = 103 ) , and those not undergoing thoracoscopy ( n = 114 ) were r and omized to 1 of 4 groups ( 24F chest tube and opioids [ n = 28 ] ; 24F chest tube and NSAIDs [ n = 29 ] ; 12F chest tube and opioids [ n = 29 ] ; or 12F chest tube and NSAIDs [ n = 28 ] ) . MAIN OUTCOMES AND MEASURES Pain while chest tube was in place ( 0- to 100-mm visual analog scale [ VAS ] 4 times/d ; superiority comparison ) and pleurodesis efficacy at 3 months ( failure defined as need for further pleural intervention ; noninferiority comparison ; margin , 15 % ) . RESULTS Pain scores in the opiate group ( n = 150 ) vs the NSAID group ( n = 144 ) were not significantly different ( mean VAS score , 23.8 mm vs 22.1 mm ; adjusted difference , -1.5 mm ; 95 % CI , -5.0 to 2.0 mm ; P = .40 ) , but the NSAID group required more rescue analgesia ( 26.3 % vs 38.1 % ; rate ratio , 2.1 ; 95 % CI , 1.3 - 3.4 ; P = .003 ) . Pleurodesis failure occurred in 30 patients ( 20 % ) in the opiate group and 33 ( 23 % ) in the NSAID group , meeting criteria for noninferiority ( difference , -3 % ; 1-sided 95 % CI , -10 % to ∞ ; P = .004 for noninferiority ) . Pain scores were lower among patients in the 12F chest tube group ( n = 54 ) vs the 24F group ( n = 56 ) ( mean VAS score , 22.0 mm vs 26.8 mm ; adjusted difference , -6.0 mm ; 95 % CI , -11.7 to -0.2 mm ; P = .04 ) and 12F chest tubes vs 24F chest tubes were associated with higher pleurodesis failure ( 30 % vs 24 % ) , failing to meet noninferiority criteria ( difference , -6 % ; 1-sided 95 % CI , -20 % to ∞ ; P = .14 for noninferiority ) . Complications during chest tube insertion occurred more commonly with 12F tubes ( 14 % vs 24 % ; odds ratio , 1.91 ; P = .20 ) . CONCLUSIONS AND RELEVANCE Use of NSAIDs vs opiates result ed in no significant difference in pain scores but was associated with more rescue medication . NSAID use result ed in noninferior rates of pleurodesis efficacy at 3 months . Placement of 12F chest tubes vs 24F chest tubes was associated with a statistically significant but clinical ly modest reduction in pain but failed to meet noninferiority criteria for pleurodesis efficacy . TRIAL REGISTRATION is rct n.org Identifier : IS RCT N33288337 BACKGROUND Symptomatic malignant pleural effusion ( MPE ) occurs frequently in patients with metastatic cancer . The associated prognosis is poor and the success rate of talc pleurodesis ( TP ) is low . Indwelling pleural catheters ( IPCs ) are commonly inserted when TP has been unsuccessful . METHODS We compared talc pleurodesis with the use of an indwelling pleural catheter in patients with recurrent MPE in a multicenter r and omized controlled trial ( superiority design ) . The primary endpoint was improvement from baseline in Modified Borg Score ( MBS ) 6weeks after r and omized treatment . Secondary endpoints were hospitalization days , re- interventions , and adverse events . RESULTS Dyspnea improved significantly ( p<0.01 ) after either treatment , but the magnitude of this improvement did not differ significantly between arms ( median 3 and 1 for TP : IPC respectively in rest , p=0.16 , ( TP 13:IPC 16 ) and 3 and 1 during exercise , p=0.72 ( TP 13:IPC 17 ) ) . There was no difference in dyspnea during exercise between TP and IPC at week 6 following treatment , while at rest TP patients ( n=13 ) reported less dyspnea than IPC patients ( n=18 ) ( median 0 vs 1 , p=0.002 ) . Compared to TP , patients with an IPC had significantly less hospital days during r and omized treatment ( median : 0 vs 5 , p<0.0001 ) , and total hospitalizations for all causes ( median : 1.6 vs 1.0 , p=0.0035 ) . Fewer IPC patients underwent more than one re-intervention ( 7/45 vs 15/43 , p=0.09 ) . The mean number of re- interventions was lower following IPC ( 0.21 vs 0.53 , p=0.05 ) . Equal number of adverse events occurred . CONCLUSIONS IPC was not superior in the primary endpoint , improvement of the modified Borg scale ( MBS ) . However , IPC patients had lower hospital stay , fewer admissions and fewer re- interventions . The IPC is an effective treatment modality in patients with symptomatic malignant pleural effusion The purpose of this study was to compare the effectiveness and safety of a chronic indwelling pleural catheter with doxycycline pleurodesis via tube thoracostomy in the treatment of patients with recurrent symptomatic malignant pleural effusions ( MPE ) STUDY OBJECTIVE To demonstrate the efficacy , safety , and appropriate mode of instillation of talc for sclerosis in treatment of malignant pleural effusions ( MPEs ) . DESIGN A prospect i ve , r and omized trial was design ed to compare thoracoscopy with talc insufflation ( TTI ) to thoracostomy and talc slurry ( TS ) for patients with documented MPE . MEASUREMENTS The primary end point was 30-day freedom from radiographic MPE recurrence among surviving patients whose lungs initially re-exp and ed > 90 % . Morbidity , mortality , and quality of life were also assessed . RESULTS Of 501 patients registered , those eligible were r and omized to TTI ( n = 242 ) or TS ( n = 240 ) . Patient demographics and primary malignancies were similar between study arms . Overall , there was no difference between study arms in the percentage of patients with successful 30-day outcomes ( TTI , 78 % ; TS , 71 % ) . However , the subgroup of patients with primary lung or breast cancer had higher success with TTI than with TS ( 82 % vs 67 % ) . Common morbidity included fever , dyspnea , and pain . Treatment-related mortality occurred in nine TTI patients and seven TS patients . Respiratory complications were more common following TTI than TS ( 14 % vs 6 % ) . Respiratory failure was observed in 4 % of TS patients and 8 % of TTI patients , accounting for five toxic deaths and six toxic deaths , respectively . Quality -of-life measurement demonstrated less fatigue with TTI than TS . Patient ratings of comfort and safety were also higher for TTI , but there were no differences on perceived value or convenience of the procedures . CONCLUSIONS Both methods of talc delivery are similar in efficacy ; TTI may be better for patients with either a lung or breast primary . The etiology and incidence of respiratory complications from talc need further exploration BACKGROUND Patients with malignant pleural effusion ( MPE ) have limited prognoses . They require long-lasting symptom relief with minimal hospitalization . Indwelling pleural catheters ( IPCs ) and talc pleurodesis are approved treatments for MPE . Establishing the implication s of IPC and talc pleurodesis on subsequent hospital stay will influence patient choice of treatment . Therefore , our objective was to compare patients with MPE treated with IPC vs pleurodesis in terms of hospital bed days ( from procedure to death or end of follow-up ) and safety . METHODS In this prospect i ve , 12-month , multicenter study , patients with MPE were treated with IPC or talc pleurodesis , based on patient choice . Key end points were hospital bed days from procedure to death ( total and effusion-related ) . Complications , including infection and protein depletion , were monitored longitudinally . RESULTS One hundred sixty patients with MPE were recruited , and 65 required definitive fluid control ; 34 chose IPCs and 31 pleurodesis . Total hospital bed days ( from any causes ) were significantly fewer in patients with IPCs ( median , 6.5 days ; interquartile range [ IQR ] = 3.75 - 13.0 vs pleurodesis , mean , 18.0 ; IQR , 8.0 - 26.0 ; P = .002 ) . Effusion-related hospital bed days were significantly fewer with IPCs ( median , 3.0 days ; IQR , 1.8 - 8.3 vs pleurodesis , median , 10.0 days ; IQR , 6.0 - 18.0 ; P < .001 ) . Patients with IPCs spent significantly fewer of their remaining days of life in hospital ( 8.0 % vs 11.2 % , P < .001 , χ(2 ) = 28.25 ) . Fewer patients with IPCs required further pleural procedures ( 13.5 % vs 32.3 % in pleurodesis group ) . There was no difference in rates of pleural infection ( P = .68 ) and protein ( P = .65 ) or albumin loss ( P = .22 ) . More patients treated with IPC reported immediate ( within 7 days ) improvements in quality of life and dyspnea . CONCLUSIONS Patients treated with IPCs required significantly fewer days in hospital and fewer additional pleural procedures than those who received pleurodesis . Safety profiles and symptom control were comparable CONTEXT Malignant pleural effusion causes disabling dyspnea in patients with a short life expectancy . Palliation is achieved by fluid drainage , but the most effective first-line method has not been determined . OBJECTIVE To determine whether indwelling pleural catheters ( IPCs ) are more effective than chest tube and talc slurry pleurodesis ( talc ) at relieving dyspnea . DESIGN Unblinded r and omized controlled trial ( Second Therapeutic Intervention in Malignant Effusion Trial [ TIME2 ] ) comparing IPC and talc ( 1:1 ) for which 106 patients with malignant pleural effusion who had not previously undergone pleurodesis were recruited from 143 patients who were treated Output:

No differences in survival or measures of dyspnea were observed in any of the studies . No differences were noted in other adverse events . Conclusions : Compared with chemical pleurodesis , IPC results in shorter hospital length of stay and fewer repeat pleural procedures but carries a higher risk of cellulitis .

MS2_1shot405

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Pre clinical data suggest that combining a checkpoint inhibition with immunomodulatory derivative can increase anticancer response . We design ed a dose-escalation study using a 3 + 3 design to determine the safety , maximum tolerated dose ( MTD ) or recommended phase II dose ( R2PD ) and dose-limiting toxicities ( DLT ) of the anti – CTLA-4 antibody ipilimumab ( 1.5–3 mg/kg intravenously every 28 days × 4 ) and lenalidomide ( 10–25 mg orally daily for 21 of 28 days until disease progression or unacceptable toxicity ) in advanced cancers . Total of 36 patients ( Hodgkin lymphoma , 7 ; melanoma , 5 ; leiomyosarcoma , 4 ; renal cancer , 3 ; thyroid cancer , 3 ; other cancers , 14 ; median of 3 prior therapies ) were enrolled . The MTD has not been reached and ipilimumab 3 mg/kg and lenalidomide 25 mg have been declared as R2PD . DLT were grade ( G ) 3 rash ( 3 patients ) and G3 pancreatitis ( 1 patient ) . G3/4 drug-related toxicities other than DLT were G3 anemia ( 5 patients ) , G3 thromboembolism ( 2 patients ) , G3 thrombocytopenia , G3 rash , G3 hypopituitarism , G3 pneumonitis , G3 transaminitis , and G4 hypopituitarism ( all in 1 patient ) . Eight patients had tumor shrinkage per immune-related response criteria ( −79 % to −2 % ) including a PR ( −79 % for 7.2 + months ) in a refractory Hodgkin lymphoma . Using comprehensive genomic profiling , a total mutation burden ( mutations/Mb ) was evaluated in 17 patients , with one of the patients achieving a PR demonstrated intermediate mutation burden . In conclusion , combination of ipilimumab and lenalidomide is well tolerated and demonstrated preliminary signals of activity in patients with refractory Hodgkin lymphoma and other advanced cancers . Mol Cancer Ther ; 17(3 ) ; 671–6 . © 2017 AACR The incidence of esophagogastric cancer is rapidly rising , but only a minority of patients derive durable benefit from current therapies . Chemotherapy as well as anti-HER2 and PD-1 antibodies are st and ard treatments . To identify predictive biomarkers of drug sensitivity and mechanisms of resistance , we implemented prospect i ve tumor sequencing of patients with metastatic esophagogastric cancer . There was no association between homologous recombination deficiency defects and response to platinum-based chemotherapy . Patients with microsatellite instability-high tumors were intrinsically resistant to chemotherapy but more likely to achieve durable responses to immunotherapy . The single Epstein-Barr virus-positive patient achieved a durable , complete response to immunotherapy . The level of ERBB2 amplification as determined by sequencing was predictive of trastuzumab benefit . Selection for a tumor subclone lacking ERBB2 amplification , deletion of ERBB2 exon 16 , and comutations in the receptor tyrosine kinase , RAS , and PI3 K pathways were associated with intrinsic and /or acquired trastuzumab resistance . Prospect i ve genomic profiling can identify patients most likely to derive durable benefit to immunotherapy and trastuzumab and guide strategies to overcome drug resistance . Significance : Clinical application of multiplex sequencing can identify biomarkers of treatment response to contemporary systemic therapies in metastatic esophagogastric cancer . This large prospect i ve analysis sheds light on the biological complexity and the dynamic nature of therapeutic resistance in metastatic esophagogastric cancers . Cancer Discov ; 8(1 ) ; 49 - 58 . © 2017 AACR.See related commentary by Sundar and Tan , p. 14See related article by Pectasides et al. , p. 37This article is highlighted in the In This Issue feature , p. 1 Purpose Alterations in DNA damage response and repair ( DDR ) genes are associated with increased mutation load and improved clinical outcomes in platinum-treated metastatic urothelial carcinoma . We examined the relationship between DDR alterations and response to PD-1/PD-L1 blockade . Methods Detailed demographic , treatment response , and long-term outcome data were collected on patients with metastatic urothelial carcinoma treated with atezolizumab or nivolumab who had targeted exon sequencing performed on pre-immunotherapy tumor specimens . Presence of DDR alterations was correlated with best objective response per Response Evaluation Criteria in Solid Tumors ( RECIST ) and progression-free and overall survival . Results Sixty patients with urothelial cancer enrolled in prospect i ve trials of anti-PD-1/PD-L1 antibodies met inclusion criteria . Any DDR and known or likely deleterious DDR mutations were identified in 28 ( 47 % ) and 15 ( 25 % ) patients , respectively . The presence of any DDR alteration was associated with a higher response rate ( 67.9 % v 18.8 % ; P < .001 ) . A higher response rate was observed in patients whose tumors harbored known or likely deleterious DDR alterations ( 80 % ) compared with DDR alterations of unknown significance ( 54 % ) and in those whose tumors were wild-type for DDR genes ( 19 % ; P < .001 ) . The correlation remained significant in multivariable analysis that included presence of visceral metastases . DDR alterations also were associated with longer progression-free and overall survival . Conclusion DDR alterations are independently associated with response to PD-1/PD-L1 blockade in patients with metastatic urothelial carcinoma . These observations warrant additional study , including prospect i ve validation and exploration of the interaction between tumor DDR alteration and other tumor/host biomarkers of immunotherapy response Background Inhibition of programmed death-lig and 1 ( PD-L1 ) with atezolizumab can induce durable clinical benefit ( DCB ) in patients with metastatic urothelial cancers , including complete remissions in patients with chemotherapy refractory disease . Although mutation load and PD-L1 immune cell ( IC ) staining have been associated with response , they lack sufficient sensitivity and specificity for clinical use . Thus , there is a need to evaluate the peripheral blood immune environment and to conduct detailed analyses of mutation load , predicted neoantigens , and immune cellular infiltration in tumors to enhance our underst and ing of the biologic underpinnings of response and resistance . Methods and findings The goals of this study were to ( 1 ) evaluate the association of mutation load and predicted neoantigen load with therapeutic benefit and ( 2 ) determine whether intratumoral and peripheral blood T cell receptor ( TCR ) clonality inform clinical outcomes in urothelial carcinoma treated with atezolizumab . We hypothesized that an elevated mutation load in combination with T cell clonal dominance among intratumoral lymphocytes prior to treatment or among peripheral T cells after treatment would be associated with effective tumor control upon treatment with anti-PD-L1 therapy . We performed whole exome sequencing ( WES ) , RNA sequencing ( RNA-seq ) , and T cell receptor sequencing ( TCR-seq ) of pretreatment tumor sample s as well as TCR-seq of matched , serially collected peripheral blood , collected before and after treatment with atezolizumab . These parameters were assessed for correlation with DCB ( defined as progression-free survival [ PFS ] > 6 months ) , PFS , and overall survival ( OS ) , both alone and in the context of clinical and intratumoral parameters known to be predictive of survival in this disease state . Patients with DCB displayed a higher proportion of tumor-infiltrating T lymphocytes ( TIL ) ( n = 24 , Mann-Whitney p = 0.047 ) . Pretreatment peripheral blood TCR clonality below the median was associated with improved PFS ( n = 29 , log-rank p = 0.048 ) and OS ( n = 29 , log-rank p = 0.011 ) . Patients with DCB also demonstrated more substantial expansion of tumor-associated TCR clones in the peripheral blood 3 weeks after starting treatment ( n = 22 , Mann-Whitney p = 0.022 ) . The combination of high pretreatment peripheral blood TCR clonality with elevated PD-L1 IC staining in tumor tissue was strongly associated with poor clinical outcomes ( n = 10 , hazard ratio ( HR ) ( mean ) = 89.88 , HR ( median ) = 23.41 , 95 % CI [ 2.43 , 506.94 ] , p(HR > 1 ) = 0.0014 ) . Marked variations in mutation loads were seen with different somatic variant calling method ologies , which , in turn , impacted associations with clinical outcomes . Missense mutation load , predicted neoantigen load , and expressed neoantigen load did not demonstrate significant association with DCB ( n = 25 , Mann-Whitney p = 0.22 , n = 25 , Mann-Whitney p = 0.55 , and n = 25 , Mann-Whitney p = 0.29 , respectively ) . Instead , we found evidence of time-varying effects of somatic mutation load on PFS in this cohort ( n = 25 , p = 0.044 ) . A limitation of our study is its small sample size ( n = 29 ) , a subset of the patients treated on IMvigor 210 ( NCT02108652 ) . Given the number of exploratory analyses performed , we intend for these results to be hypothesis-generating . Conclusions These results demonstrate the complex nature of immune response to checkpoint blockade and the compelling need for greater interrogation and data integration of both host and tumor factors . Incorporating these variables in prospect i ve studies will facilitate identification and treatment of resistant patients BACKGROUND Nivolumab plus ipilimumab showed promising efficacy for the treatment of non – small‐cell lung cancer ( NSCLC ) in a phase 1 trial , and tumor mutational burden has emerged as a potential biomarker of benefit . In this part of an open‐label , multipart , phase 3 trial , we examined progression‐free survival with nivolumab plus ipilimumab versus chemotherapy among patients with a high tumor mutational burden ( ≥10 mutations per megabase ) . METHODS We enrolled patients with stage IV or recurrent NSCLC that was not previously treated with chemotherapy . Those with a level of tumor programmed death lig and 1 ( PD‐L1 ) expression of at least 1 % were r and omly assigned , in a 1:1:1 ratio , to receive nivolumab plus ipilimumab , nivolumab monotherapy , or chemotherapy ; those with a tumor PD‐L1 expression level of less than 1 % were r and omly assigned , in a 1:1:1 ratio , to receive nivolumab plus ipilimumab , nivolumab plus chemotherapy , or chemotherapy . Tumor mutational burden was determined by the FoundationOne CDx assay . RESULTS Progression‐free survival among patients with a high tumor mutational burden was significantly longer with nivolumab plus ipilimumab than with chemotherapy . The 1‐year progression‐free survival rate was 42.6 % with nivolumab plus ipilimumab versus 13.2 % with chemotherapy , and the median progression‐free survival was 7.2 months ( 95 % confidence interval [ CI ] , 5.5 to 13.2 ) versus 5.5 months ( 95 % CI , 4.4 to 5.8 ) ( hazard ratio for disease progression or death , 0.58 ; 97.5 % CI , 0.41 to 0.81 ; P<0.001 ) . The objective response rate was 45.3 % with nivolumab plus ipilimumab and 26.9 % with chemotherapy . The benefit of nivolumab plus ipilimumab over chemotherapy was broadly consistent within subgroups , including patients with a PD‐L1 expression level of at least 1 % and those with a level of less than 1 % . The rate of grade 3 or 4 treatment‐related adverse events was 31.2 % with nivolumab plus ipilimumab and 36.1 % with chemotherapy . CONCLUSIONS Progression‐free survival was significantly longer with first‐line nivolumab plus ipilimumab than with chemotherapy among patients with NSCLC and a high tumor mutational burden , irrespective of PD‐L1 expression level . The results vali date the benefit of nivolumab plus ipilimumab in NSCLC and the role of tumor mutational burden as a biomarker for patient selection . ( Funded by Bristol‐Myers Squibb and Ono Pharmaceutical ; CheckMate 227 Clinical Trials.gov number , NCT02477826 . BACKGROUND Nivolumab , a fully human IgG4 programmed death 1 ( PD-1 ) immune-checkpoint-inhibitor antibody , disrupts PD-1-mediated signaling and may restore antitumor immunity . METHODS In this r and omized , open-label , international phase 3 study , we assigned patients with nonsquamous non-small-cell lung cancer ( NSCLC ) that had progressed during or after platinum-based doublet chemotherapy to receive nivolumab at a dose of 3 mg per kilogram of body Output:

Subgroup analyses showed the predictive value of TMB was significant in non-small-cell lung cancer ( except for the OS ) and melanoma . In addition , heterogeneity was substantial in targeted next generation sequencing group but tiny in whole exome sequencing group . Furthermore , TMB and PD-L1 expression were capable to predict improved ORR of ICIs after stratification of each other , with tiny heterogeneity . Moreover , tumor mutation burden and programmed cell death lig and 1 expression were independent factors on predicting efficacy of immune checkpoint inhibitors

MS2_1shot406

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: This study investigated how newly walking toddlers with Down syndrome ( DS ) , after different treadmill interventions , adopted clearance strategies and modified anticipatory locomotor adjustment patterns to negotiate an obstacle in their travel path . Thirty infants with DS ( about 10 months of age ) were recruited and r and omly assigned to either a lower-intensity , generalized ( LG ) treadmill training group , or a higher-intensity , individualized ( HI ) treadmill training group . Thirteen in each group completed a one-year-gait follow-up after the treadmill intervention . Initially , both groups chose to either crawl or walk over an obstacle . However , walking over the obstacle became their preferred clearance strategy over the course of the gait follow-up even though the height of the obstacle increased from visit to visit . The HI group used the strategy of walking over the obstacle at a considerably higher percentage than the LG group within 6 months after the training . When approaching the obstacle , both groups started to show consistent anticipatory locomotor adjustments about 6 months after the training . Both groups decreased velocity , cadence and step length , and increased step width at the last three pre-obstacle steps . It was concluded that the retention of the HI training effects led the HI group to predominantly walk over an obstacle earlier than the LG group within 6 months after treadmill intervention , and the two groups produced similar anticipatory locomotor adjustments in the last three steps before negotiating the obstacle Intellectual disability affects all spheres of people 's lives who suffer from it . It lowers the level of intellectual functioning , often stigmatizes , characteristically changing features , and decreases motor performance . Unfortunately , modern medicine can not cure intellectual disability ; however , there is a chance to improve the quality of life of people with mental retardation by means of physical exercises and by enhancing coordination , the quality of gait and efficiency in performing everyday activities . This paper deals with observations of static balance in 40 young females and males with mild Down syndrome , out of which 20 were subjected to a three-month sensorimotor training programme . The participants performed exercises with rehabilitation balls and air pillows twice a week , and the remaining persons constituted a control group . The balance platform test conducted at the beginning of the experiment revealed that the level of static one-legged balance was similar in both groups . A significant difference was noted in the length of the path of the general centre of gravity ( COG ) and the time frame in which the vertical projection of COG remained within the 13 mm radius circle , between the result of the test conducted under visual control and with the eyes closed , both in the group of the participants performing exercises and the ones who did not do them . After the training sessions the results of both tests improved in the group of the persons subjected to the training programme , however differences between the groups were not statistically significant , apart from the comparison of the time of keeping COG within the 13 mm radius circle at the beginning and at the end of the experiment by the participants who were physically active . Our results lead to a conclusion that exercises with the use of unstable surfaces improve deep sensibility in people with mild mental retardation Objective : The aim of the study was to determine the effect of exercise training on strength and balance in children with Down ’s syndrome . Design : R and omized controlled trial . Setting : Rehabilitation school for special children . Subjects and intervention : Twenty-three children were r and omized to intervention and control group . The intervention group ( n = 12 ) underwent progressive resistive exercises for lower limbs and balance training for six weeks . The control group continued their regular activities followed at school . Outcome measure : A h and held dynamometer was used to measure the lower limb muscle strength . Balance was assessed by the balance subscale of Bruininks Oseretsky Test of Motor Proficiency ( BOTMP ) . Results : Following the training , the children in the intervention group showed a statistically significant improvement ( P < 0.05 ) in the lower limb strength of all the muscle groups assessed . The strength of knee extensors was 12.12 lbs in the control group versus 18.4 lbs in the experimental group ; in hip flexors it was 12.34 lbs in the control group versus 16.66 lbs in the experimental group post-intervention . The balance of the children also improved significantly with an improvement in scores of the balance subscale of BOTMP ( 19.50 in the experimental group versus 9.00 in the control group , P = 0.001 ) . Conclusion : This study suggests that a specific exercise training programme may improve the strength and balance in children with Down ’s Background Infants with Down syndrome ( DS ) have delayed walking and produce less-coordinated walking patterns . Objective The aim of this study was to investigate whether 2 treadmill interventions would have different influences on the development of joint kinematic patterns in infants with DS . Design Thirty infants with DS were r and omly assigned to a lower-intensity , generalized ( LG ) treadmill training group ( LG group ) or a higher-intensity , individualized ( HI ) treadmill training group ( HI group ) and trained until walking onset . Twenty-six participants ( 13 in each group ) completed a 1-year gait follow-up assessment . Methods During the gait follow-up assessment , reflective markers were placed bilaterally on the participants to measure the kinematic patterns of the hip , knee , and ankle joints . Both the timing and the magnitude of peak extension and flexion at the hip , knee , and ankle joints , as well as peak adduction and abduction at the hip joint , in the 2 groups were compared . Results Both the LG group and the HI group showed significantly advanced development of joint kinematics at the gait follow-up . In the HI group , peak ankle plantar flexion occurred at or before toe-off , and the duration of the forward thigh swing after toe-off increased . Limitations Joint kinematics in the lower extremities were evaluated in this study . It would be interesting to investigate the effect of treadmill interventions on kinematic patterns in the trunk and arm movement . Conclusions The timing of peak ankle plantar flexion ( before toe-off ) in the HI group implies further benefits from the HI intervention ; that is , the HI group may use mechanical energy transfer better at the end of stance and may show decreased hip muscle forces and moments during walking . It was concluded that the HI intervention can accelerate the development of joint kinematic patterns in infants with DS within 1 year after walking onset BACKGROUND Longer life expectancy is result ing in increasing numbers of elderly adults with mental retardation . In elderly adults with Down syndrome ( DS ) , the maintenance of muscle strength , endurance , and dynamic balance are important to ensure quality of life and functional independence . The objective of this study was to compare isokinetic leg strength and dynamic balance of aged mentally retarded individuals with DS ( n = 16 , mean age 63 ) before and after a treadmill walking program lasting 6 months in comparison with a nonwalking control group ( n = 10 ) with similar physical characteristics . METHODS Participants in the study undertook leg strength testing on a dynamometer . Parameters measured included peak torque , peak torque % body weight , and average power % body weight . A " timed get-up and go " functional test for dynamic balance was also analyzed and compared prior to and after the treadmill program . RESULTS Knee extension and flexion isokinetic strength in elderly individuals with DS showed significant improvement after 6 months of treadmill training . Dynamic balance performance was also significantly improved ( p < .05 ) . CONCLUSIONS Aged adults with DS can significantly improve muscle strength and balance by adopting suitable programs of treadmill walking The main objective of this study is to underst and the differences in equilibrium control between normal subjects and those with Down syndrome . A total of 54 subjects participated voluntarily , divided into control group and Down syndrome group . The equilibrium of the subjects was tested under two conditions : bipedal support with eyes open and closed . The signals were analyzed in a time and frequency domain . The statistical parameters selected ( i.e. , RMS distance , mean velocity , mean frequency and sway area ) to analyze the behavior of the center of pressures ( CoP ) are calculated employing the result of the combination of the time series data in both directions ( i.e. result ant distance ) . In order to calculate the frequency b and s produced by the displacements of the CoP , a Fast Fourier Transform of the data was performed . The group with Down syndrome showed poorer static equilibrium control than the control group in the time domain . In the frequency domain , we found differences between the groups in the distribution of energy in the frequency b and s analyzed . In addition , we observed the existence of an interaction effect of the group and the condition tested ( p<0.001 ) . These findings show that in the absence of visual information , the control group increases the energy at low frequencies , while the group with Down syndrome decreases it . Additionally , the lower amount of energy observed in this b and under the ' eyes closed ' condition may serve to identify abnormalities in the functioning of the vestibular apparatus of individuals with Down syndrome and /or difficulties experienced by these individuals in extracting relevant information from this route Objective : Compare the effects of treadmill training and training with overground walking ( both without partial weight support ) on motor skills in children with cerebral palsy . Design : R and omized controlled clinical trial . Setting : Physical therapy clinics . Subjects : Thirty-six children with cerebral palsy ( levels I – III of the Gross Motor Functional Classification System ) r and omly divided into two intervention groups . Interventions : Experimental group ( 17 children ) su bmi tted to treadmill training without partial weight support . Overground walking group ( 18 children ) su bmi tted to gait training on a fixed surface ( ground ) . Training was performed for seven consecutive weeks ( two sessions per week ) , with four subsequent weeks of follow-up . Results : Both groups demonstrated improvements on the 6-minute walk test ( experimental group from 227.4 SD 49.4 to 377.2 SD 93.0 ; overground walking group from 222.6 SD 42.6 to 268.0 SD 45.0 ) , timed up- and -go test ( experimental group from 14.3 SD 2.9 to 7.8 SD 2.2 ; overground walking group from 12.8 SD 2.2 to 10.5 SD 2.5 ) , Pediatric Evaluation Disability Inventory ( experimental group from 128.0 SD 19.9 to 139.0 SD 18.4 ; overground walking group from 120.8 SD 19.0 to 125.8 SD 12.2 ) , Gross Motor Function Measure-88 ( experimental group from 81.6 SD 8.7 to 93.0 SD 5.7 ; overground walking group from 77.3 SD 7.0 to 80.8 SD 7.2 ) , Berg Balance Scale ( experimental group from 34.9 SD 8.5 to 46.7 SD 7.6 ; overground walking group from 31.9 SD 7.0 to 35.7 SD 6.8 ) after treatment . The experimental group demonstrated greater improvements than the overground walking group both after treatment and during follow up ( p < 0.05 ) . Conclusion : Treadmill training proved more effective than training with overground walking regarding functional mobility , functional performance , gross motor function and functional balance in children with cerebral palsy Purpose . To assess postural control in individuals with Down syndrome . Method . Sixty young adults with Down syndrome were assessed and compared to 10 non-h and icapped young . The subjects were asked to stay on a force platform for 30 seconds . Postural control was evaluated in two conditions : open and closed eyes . The kinetic data carried out from the force platform ( i.e. , ground reaction forces and Center of Pression ( COP ) displacements ) were both evaluated in time domain and in frequency domain . Results . Patients with Down syndrome are characterized by instable postural control . In particular the data evaluation in frequency domain underlined for Down syndrome subjects versus control group an increase in frequency oscillation both in anterior-posterior and in medio-lateral direction , that are confirmed in time domain analysis only for medio-lateral direction . In DS no changes are evident between eyes open and eyes closed condition . Conclusion . This study finds that subjects with Down syndrome included in this research demonstrate that deficits in postural control system that may provide a partial explanation for function balance problems that are common in these subjects ABSTRACT PEDro is produced by the Centre for Evidence -Based Physiotherapy ( CEBP ) , located in Sydney , Australia . PEDro is intended to be used to gain “ rapid access to bibliographic details and abstract s of r and omized controlled trials , systematic review s and evidence -based clinical practice guidelines in physiotherapy.”1 This column will provide some background information on the data base , as well as cover the basics of search ing its content People suffering from Ehlers-Danlos syndrome ( EDS ) hypermobility type present a severe ligament laxity that results in difficulties in muscle force transmission . The same condition is present in people suffering from Down syndrome ( DS ) even if their clumsy movements are due to cerebral and cognitive impairments . The aim of this study was to quantify the gait patterns of subjects with EDS and with DS using Gait Analysis ( GA ) . We quantified the gait strategy in 12 EDS individuals and in 16 participants with DS . Both pathological groups were compared to 20 age-matched healthy controls in terms of kinematics and kinetics . Results showed that DS individuals are characterized by a more compromised gait pattern than EDS participants , even if both groups are characterized by joint hypermobility . All the patients showed significant decreased of ankle stiffness probably due to congenital hypotonia and ligament laxity , while different values of hip stiffness . These findings help to eluci date the complex biomechanical changes due to joint hypermobility and may have a major role in the multidimensional evaluation and tailored management of these patients Children with Down ’s syndrome ( DS ) often have greater postural sway and delay in motor development . Muscle weakness and hypotonia , particularly of the lower extremities , are theorized to impair their overall physical health and ability to perform daily activities . Therefore , the aim of this study was to investigate the effects of isokinetic training on muscle strength and Output:

[ Conclusion ] A number of compensatory patterns during movement was observed , with a direct influence on improvements in stability and postural control throughout daily life . Intensive gait training at an early age appears to produce long-term improvements in this population .

MS2_1shot407

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: PURPOSE The purpose of our study was to evaluate the effect of cognitive behavioral therapy ( CBT ) , physical exercise ( PE ) , and of these two interventions combined ( CBT/PE ) on menopausal symptoms ( primary outcome ) , body image , sexual functioning , psychological well-being , and health-related quality of life ( secondary outcomes ) in patients with breast cancer experiencing treatment-induced menopause . PATIENTS AND METHODS Patients with breast cancer reporting treatment-induced menopausal symptoms ( N=422 ) were r and omly assigned to CBT ( n=109 ) , PE ( n=104 ) , CBT/PE ( n=106 ) , or to a waiting list control group ( n=103 ) . Self-report question naires were completed at baseline , 12 weeks , and 6 months . Multilevel procedures were used to compare the intervention groups with the control group over time . RESULTS Compared with the control group , the intervention groups had a significant decrease in levels of endocrine symptoms ( Functional Assessment of Cancer Therapy-Endocrine Symptoms ; P<.001 ; effect size , 0.31 - 0.52 ) and urinary symptoms ( Bristol Female Lower Urinary Tract Symptoms Question naire ; P=.002 ; effect size , 0.29 - 0.33 ) , and they showed an improvement in physical functioning ( 36-Item Short Form Health Survey physical functioning subscale ; P=.002 ; effect size , 0.37 - 0.46 ) . The groups that included CBT also showed a significant decrease in the perceived burden of hot flashes and night sweats ( problem rating scale of the Hot Flush Rating Scale ; P<.001 ; effect size , 0.39 - 0.56 ) and an increase in sexual activity ( Sexual Activity Question naire habit subscale ; P=.027 ; effect size , 0.65 ) . Most of these effects were observed at both the 12-week and 6-month follow-ups . CONCLUSION CBT and PE can have salutary effects on endocrine symptoms and , to a lesser degree , on sexuality and physical functioning of patients with breast cancer experiencing treatment-induced menopause . Future work is needed to improve the design and the planning of these interventions to improve program adherence Sexual dysfunction is present the most important problem among menopausal women and thus counseling may have a major role for improving menopausal sexual state in this population . We aim ed to assess effects of counseling on sexual function of menopause women and their spouses . An interventional trial study was performed on 120 consecutive Iranian couples ( menopause women and their spouses ) who were resident in Hamadan , Iran in 2015 . The subjects were r and omly assigned to receive counseling service ( n = 60 ) or did not receive this service ( n = 60 ) . Couples were asked to complete a st and ardized vali date d question naire assessing sexual function and behaviors . The frequency of sexual intercourse was considerably increased following first and second counseling sessions compared with the time before counseling in former group , while sexually state was remained unchanged in those who not received these counseling . Furthermore , dyspareunia in interventional women with counseling was significantly reduced after the first and second counseling , whereas this complaint was not significantly removed in the control group within the study period . Also , unsuccessful intercourse was significantly decreased in men who received counseling sessions , while this parameter was remained unchanged in other men . In addition , talking with the partner about sexually and Satisfaction degree of wife ’s love was significantly improved in both men and women in interventional groups compared with the control groups . Active and structured counseling effectively improve sexual functions and behaviors in menopausal women and their spouses Although a large number of studies report the impact of daily exercise on many aspects of women 's health , none of them address the relationship between Pilates exercise and sexual function prospect ively . The aim of this study was to assess the effect of Pilates exercise on sexual function in healthy young women using a vali date d question naire . In total , 34 premenopausal healthy Turkish women aged between 20 and 50 years who had regular menstrual cycles and sexual relationships were included in the study . Women were asked to complete Beck Depression Inventory ( BDI ) and Female Sexual Function Index ( FSFI ) question naires . Question naires were completed before and after 12 weeks of Pilates exercise . Primary endpoints were changes in total and individual domain scores on the FSFI and BDI . After the 12-week Pilates intervention , BDI scores were decreased and all domains of the FSFI were significantly improved with mean ± SD total FSFI scores increasing from 25.9 ± 7.4 to 32.2 ± 3.6 ( p < .0001 ) . This is the first prospect i ve study that quantifies the improvement in sexual function of healthy women after a 12-week Pilates program . Our findings suggest that Pilates may improve sexual function in healthy women . However , further studies with a larger sample size are needed in this field OBJECTIVE To examine the effects of " Rusie Dutton " on health and quality of life in menopausal women . METHOD Menopausal women ( aged 45 - 59 ) were recruited and r and omly allocated to 2 groups . Rusie Dutton group ( n = 24 ) practice d Rusie Dutton conducted by Wat Pho Thai Traditional Massage School for 13 weeks . The control group ( n = 26 ) was assigned to a waiting list and received no intervention . BW , BMI , restingHR , BP , flexibility , VO2max , and MENQOL including vasomotor , physical , psychosocial and sexual domains were measured at the beginning and the end . A paired- sample t-test and independent sample t-test were used for statistical analysis . RESULTS Significant improvement was found in all variables within group ( p < .05 ) in Rusie Dutton group , and a significant difference between groups was found ( p < .05 ) in all variables except BW and BMI . Therefore , it is concluded that the traditional Thai exercise Rusie Dutton can promote health related physical fitness and QOL in menopausal women BACKGROUND Moderate-to-vigorous-intensity physical activity is recommended to maintain and improve health , but the mortality benefits of light activity and risk for sedentary time remain uncertain . OBJECTIVES Using accelerometer-based measures , we 1 ) described the mortality dose-response for sedentary time and light- and moderate-to-vigorous-intensity activity using restricted cubic splines , and 2 ) estimated the mortality benefits associated with replacing sedentary time with physical activity , accounting for total activity . DESIGN US adults ( n = 4840 ) from NHANES ( 2003 - 2006 ) wore an accelerometer for ≤7 d and were followed prospect ively for mortality . Proportional hazards models were used to estimate adjusted HRs and 95 % CIs for mortality associations with time spent sedentary and in light- and moderate-to-vigorous-intensity physical activity . Splines were used to graphically present behavior-mortality relation . Isotemporal models estimated replacement associations for sedentary time , and separate models were fit for low- ( < 5.8 h total activity/d ) and high-active participants to account for nonlinear associations . RESULTS Over a mean of 6.6 y , 700 deaths occurred . Compared with less-sedentary adults ( 6 sedentary h/d ) , those who spent 10 sedentary h/d had 29 % greater risk ( HR : 1.29 ; 95 % CI : 1.1 , 1.5 ) . Compared with those who did less light activity ( 3 h/d ) , those who did 5 h of light activity/d had 23 % lower risk ( HR : 0.77 ; 95 % CI : 0.6 , 1.0 ) . There was no association with mortality for sedentary time or light or moderate-to-vigorous activity in highly active adults . In less-active adults , replacing 1 h of sedentary time with either light- or moderate-to-vigorous-intensity activity was associated with 18 % and 42 % lower mortality , respectively . CONCLUSIONS Health promotion efforts for physical activity have mostly focused on moderate-to-vigorous activity . However , our findings derived from accelerometer-based measurements suggest that increasing light-intensity activity and reducing sedentary time are also important , particularly for inactive adults Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Objective : The relationship between vulvovaginal atrophy and female sexual dysfunction is unclear . We investigated this association among sexually active postmenopausal women . Design : The Menopause Epidemiology Study is a cross-sectional , population -based study of women 40 to 65 years old in the United States chosen from a source population selected by r and om digit dialing and probability sampling . We focused on sexually active postmenopausal women ( N = 1,480 ) for our analyses . Vulvovaginal atrophy was defined as one or more of the following : vaginal dryness , itching , irritation ; pain on urination ; or pain or bleeding on intercourse . The Arizona Sexual Experience Survey was used to define female sexual dysfunction . Sexual dysfunction subtypes for desire , arousal , and orgasm difficulties were individually scored . We evaluated demographic , behavioral , reproductive history , and medication covariates for effect modification and confounding . Multivariate logistic regression was used to assess the relationship between vulvovaginal atrophy and female sexual dysfunction . Results : The prevalence of vulvovaginal atrophy ( 57 % ) and female sexual dysfunction ( 55 % ) was high . Women with female sexual dysfunction were 3.84 times more likely to have vulvovaginal atrophy than women without female sexual dysfunction ( 95 % CI : 2.99 - 4.94 ) . Hot flashes modified the association between vulvovaginal atrophy and desire difficulty . Educational level modified the association between vulvovaginal atrophy and arousal difficulty . Parity modified the association between vulvovaginal atrophy and orgasm difficulty . Conclusions : This large population -based study provides evidence of an association between vulvovaginal atrophy and overall female sexual dysfunction and its subtypes . Therapies aim ing to reduce symptoms of one condition may also relieve symptoms of the other Objective . This study was design ed to determine the effects of different short-term exercise programs on menopausal symptoms , psychological health , and quality of life in postmenopausal women . Material and Methods . Forty-two women were chosen from volunteering postmenopausal women presenting to the Department of Obstetrics and Gynecology of Bayındır Hospital between March and December 2009 . The women aged 45–60 years and experiencing menopause naturally were included in the study . They were r and omly divided into aerobic ( n = 18 ) and resistance ( n = 18 ) exercise groups . The women exercised 3 days per week for 8 weeks under the supervision of a physiotherapist . Aerobic exercise training was performed through a bicycle ergometer . Before and after the training , lipid profiles were measured and menopausal symptoms , psychological health , depression , and the quality of life were assessed through question naires . Results . In both exercise groups , no significant changes in lipid profiles were observed . In the resistance exercise group , excluding the urogenital complaints , there were significant improvements in all subscales of Menopausal Rating Scale ( MRS ) . In the resistance exercise group , excluding the phobic anxiety , there were significant improvements in all subscales of The Symptom Checklist . Depression levels significantly decreased in both groups . Improvements were observed in all subscales of menopause-specific quality of life question naire in both groups except for sexual symptoms . Conclusion . Resistance exercise and aerobic exercise were found to have a positive impact on menopausal symptoms , psychological health , depression , and quality of life Objectives The purpose of this study was to evaluate the quality of life ( QOL ) in postmenopausal members and non-members of the elderly support association in Borujen city , Iran . Methods This study was a cross-sectional descriptive study being applied to the participants were postmenopausal women of over 55 years . Thus , 40 postmenopausal members of the elderly support association of Borujen city and 40 non-members were r and omly selected . The 36 item short-form health survey ( SF-36 ) , with the 4 psychological , social , physical-movement , and environmental domains , was completed . Data were analyzed using SPSS software . Results The mean total score of QOL of member of the association was significantly greater than non-members . Student 's t-test showed a significant relationship between QOL and membership of the association ( P < 0.05 ) . One-way analysis of variance ( ANOVA ) showed that the mean QOL of postmenopausal women , according to membership and marital status ( P < 0.01 ) , housing ( P < 0.01 ) , and underlying disease ( P < 0.01 ) , was statistically significant . Conclusions According to the results , supportive measures , such as increasing the participation of the elderly in public life through proper preparations to join them and membership in peer groups such as support associations and non-governmental organizations ( NGOs ) can be greatly effective in improving QOL . The results showed that the QOL of the participants was at a moderate level and membership in support associations for the elderly was effected on the QOL in postmenopausal women . Moreover , considering the importance of the elderly in the community Background : Exercise and supplementation with isoflavones are therapies used to prevent and treat climacteric symptoms . Aim : To verify the effects of 10 weeks of combined aerobic and resistance training and isoflavone supplementation on climacteric symptoms Output:

The most commonly recommended training programs are based on exercising pelvic floor muscles , as they seem to have the largest impact on sexual function . Mind – body disciplines also helped in managing menopausal symptoms . However , as far as the most traditional programs were concerned , aerobic exercises showed inconsistent results and resistance training did not seem to convey any benefits .

MS2_1shot408

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: OBJECTIVE To examine to what extent general practitioners in consultations after a geriatric assessment set shared health priorities with older patients experiencing multimorbidity and to what extent this was facilitated through patient-centered behavior . METHODS Observation of consultations embedded in a cluster r and omized controlled trial,(1 ) in which 317 patients from 41 general practice s received the STEP assessment followed by a care planning consultation with their GPs . GPs in the intervention group used a structured procedure for setting health ( care ) priorities in contrast to control GPs . A sample of 43 consultations ( 24 intervention ; 19 control ) were recorded , transcribed and analyzed with regard to priority setting and patient-centeredness . RESULTS Patient-centeredness was only moderately apparent in consultations dealing with complex care plans for older patients with multimorbidity . The shared determination of health priorities seemed unusual for both doctors and patients and was rarely practice d , albeit more frequently in intervention consultations . CONCLUSION Setting health care priorities with patients experiencing multimorbidity is ethically desirable and medically appropriate . Yet a short structured guide for doctors can not easily achieve this . PRACTICE IMPLICATION S More research is needed in regard to h and ling complex health needs of older patients . It requires a professional approach and training in patient-centered holistic care planning BACKGROUND General Practitioners ( GPs ) often have to simultaneously tackle multiple health problems of older patients . A patient-centred process that engages the patient in setting health priorities for treatment is needed . We investigated whether a structured priority- setting consultation reconciles the often-differing doctor-patient views on the importance of problems . DESIGN Cluster r and omised controlled trial with 40 GPs and their 317 consecutively recruited older patients . PROCEDURE Following a geriatric assessment , patients and doctors independently rated the importance of each uncovered problem . GPs then selected priorities with their patients in a consultation . Trained intervention GPs held a structured consultation and utilised the list of uncovered patient problems with their importance ratings to agree priorities . Untrained control GPs only used the patient 's problem list without importance ratings . MAIN OUTCOME Doctor-patient agreement on independent importance ratings two weeks after the priority- setting consultation . ANALYSIS Weighted kappa ( κw ) and multilevel logistic regression model . RESULTS Intervention GPs and their patients determined mutual priorities for 20 % of individual problems . In this process , GPs often succeeded in convincing their patients of the importance of vaccinations , lifestyle and cognitive issues . Likewise , patients convinced their GPs to prioritise their social and functional problems . Further treatment plans ensued in 84 % of these priority areas . The regression model adjusting for clusters and baseline characteristics did not demonstrate significant differences in doctor-patient agreement on problems between groups a two weeks later . CONCLUSION Differing views on the importance of health problems between GPs and older patients were not sustainably reconciled . The special consultation facilitated identification of priority problems for treatment despite differences in perceived importance of problems between patients and GPs . German clinical trials register drks 00000792 Background : older people often experience complex problems . Because of multiple problems , care for older people in general practice needs to shift from a ‘ problem-based , disease-oriented ’ care aim ing at improvement of outcomes per disease to a ‘ goal -oriented care ’ , aim ing at improvement of functioning and personal quality of life , integrating all healthcare providers . Feasibility and cost-effectiveness of this proactive and integrated way of working are not yet established . Design : cluster r and omised trial . Participants : all persons aged ≥75 in 59 general practice s ( 30 intervention , 29 control ) , with a combination of problems , as identified with a structured postal question naire with 21 questions on four health domains . Intervention : for participants with problems on ≥3 domains , general practitioners ( GPs ) made an integrated care plan using a functional geriatric approach . Control practice s : care as usual . Outcome measures : ( i ) quality of life ( QoL ) , ( ii ) activities of daily living , ( iii ) satisfaction with delivered health care and ( iv ) cost-effectiveness of the intervention at 1-year follow-up . Trial registration : Netherl and s trial register , NTR1946 . Results : of the 11,476 registered eligible older persons , 7,285 ( 63 % ) participated in the screening . One thous and nine hundred and twenty-one ( 26 % ) had problems on ≥3 health domains . For 225 r and omly chosen persons , a care plan was made . No beneficial effects were found on QoL , patients ' functioning or healthcare use/costs . GPs experienced better overview of the care and stability , e.g. less unexpected dem and s , in the care . Conclusions : GPs prefer proactive integrated care . ‘ Horizontal ’ care using care plans for older people with complex problems can be a valuable tool in general practice . However , no direct beneficial effect was found for older persons Objective To test the effectiveness of an integrated collaborative care model for people with depression and long term physical conditions . Design Cluster r and omised controlled trial . Setting 36 general practice s in the north west of Engl and . Participants 387 patients with a record of diabetes or heart disease , or both , who had depressive symptoms ( ≥10 on patient health question aire-9 ( PHQ-9 ) ) for at least two weeks . Mean age was 58.5 ( SD 11.7 ) . Participants reported a mean of 6.2 ( SD 3.0 ) long term conditions other than diabetes or heart disease ; 240 ( 62 % ) were men ; 360 ( 90 % ) completed the trial . Interventions Collaborative care included patient preference for behavioural activation , cognitive restructuring , grade d exposure , and /or lifestyle advice , management of drug treatment , and prevention of relapse . Up to eight sessions of psychological treatment were delivered by specially trained psychological wellbeing practitioners employed by Improving Access to Psychological Therapy services in the English National Health Service ; integration of care was enhanced by two treatment sessions delivered jointly with the practice nurse . Usual care was st and ard clinical practice provided by general practitioners and practice nurses . Main outcome measures The primary outcome was reduction in symptoms of depression on the self reported symptom checklist-13 depression scale ( SCL-D13 ) at four months after baseline assessment . Secondary outcomes included anxiety symptoms ( generalised anxiety disorder 7 ) , self management ( health education impact question naire ) , disability ( Sheehan disability scale ) , and global quality of life ( WHOQOL-BREF ) . Results 19 general practice s were r and omised to collaborative care and 20 to usual care ; three practice s withdrew from the trial before patients were recruited . 191 patients were recruited from practice s allocated to collaborative care , and 196 from practice s allocated to usual care . After adjustment for baseline depression score , mean depressive scores were 0.23 SCL-D13 points lower ( 95 % confidence interval −0.41 to −0.05 ) in the collaborative care arm , equal to an adjusted st and ardised effect size of 0.30 . Patients in the intervention arm also reported being better self managers , rated their care as more patient centred , and were more satisfied with their care . There were no significant differences between groups in quality of life , disease specific quality of life , self efficacy , disability , and social support . Conclusions Collaborative care that incorporates brief low intensity psychological therapy delivered in partnership with practice nurses in primary care can reduce depression and improve self management of chronic disease in people with mental and physical multimorbidity . The size of the treatment effects were modest and were less than the prespecified effect but were achieved in a trial run in routine setting s with a deprived population with high levels of mental and physical multimorbidity . Trial registration IS RCT N80309252 PURPOSE Guided Care ( GC ) is a model of health care for multimorbid older adults that is provided by a registered nurse who works with the patients ' primary care physician ( PCP ) . The purpose of this study was to determine whether GC improves patients ' primary caregivers ' depressive symptoms , strain , productivity , and perceptions of the quality of care recipients ' chronic illness care . DESIGN AND METHODS A cluster-r and omized controlled trial of GC was conducted within 14 PCP teams . The study sample included 196 primary caregivers who completed baseline and 18-month surveys and whose care recipients remained alive and enrolled in the GC study for 18 months . Caregiver outcomes included the following : depressive symptoms ( Center for Epidemiological Studies -Depression scale ) , strain ( Modified Caregiver Strain Index ) , the quality of care recipients ' chronic illness care [ Patient Assessment of Chronic Illness Care ( PACIC ) ] , and personal productivity ( Work Productivity and Activity Impairment question naire , adapted for caregiving ) . RESULTS In multivariate regression models , between-group differences in depression , strain , work productivity , and regular activity productivity were not statistically significant after 18 months , but GC caregivers reported the overall quality of their recipients ' chronic illness care to be significantly higher ( adjusted beta = 0.40 , 95 % confidence interval : 0.14 - 0.67 ) . Quality was significantly higher in 4 of 5 PACIC subscales , reflecting the dimensions of goal setting , coordination of care , decision support , and patient activation . IMPLICATION S GC improved the quality of chronic illness care received by multimorbid care recipients but did not improve caregivers ' depressive symptoms , affect , or productivity BACKGROUND The quality of health care for older Americans with chronic conditions is suboptimal . OBJECTIVE To evaluate the effects of “ Guided Care ” on patient-reported quality of chronic illness care . DESIGN Cluster-r and omized controlled trial of Guided Care in 14 primary care teams . PARTICIPANTS Older patients of these teams were eligible to participate if , based on analysis of their recent insurance cl aims , they were at risk for incurring high health-care costs during the coming year . Small teams of physicians and their at-risk older patients were r and omized to receive either Guided Care ( GC ) or usual care (UC).INTERVENTION“Guided Care ” is design ed to enhance the quality of health care by integrating a registered nurse , trained in chronic care , into a primary care practice to work with 2–5 physicians in providing comprehensive chronic care to 50–60 multi-morbid older patients . MEASUREMENTS Eighteen months after baseline , interviewers blinded to group assignment administered the Patient Assessment of Chronic Illness Care ( PACIC ) survey by telephone . Logistic and linear regression was used to evaluate the effect of the intervention on patient-reported quality of chronic illness care . RESULTS Of the 13,534 older patients screened , 2,391 ( 17.7 % ) were eligible to participate in the study , of which 904 ( 37.8 % ) gave informed consent and were cluster-r and omized . After 18 months , 95.3 % and 92.2 % of the GC and UC recipients who remained alive and eligible completed interviews . Compared to UC recipients , GC recipients had twice greater odds of rating their chronic care highly ( aOR = 2.13 , 95 % CI = 1.30–3.50 , p = 0.003 ) . CONCLUSION Guided Care improves self-reported quality of chronic health care for multi-morbid older persons BACKGROUND The quality of health care for older Americans with multiple chronic conditions is suboptimal . We design ed " Guided Care " ( GC ) to enhance quality of care by integrating a registered nurse , intensively trained in chronic care , into primary care practice s to work with physicians in providing comprehensive chronic care to 50 - 60 multimorbid older patients . METHODS We hypothesized that GC would improve the quality of health care for this population . In 2006 , we began a cluster-r and omized controlled trial of GC at eight practice s ( n = 49 physicians ) . Older patients of these practice s were eligible to participate if they were at risk for using health services heavily during the coming year . Teams of two to five physicians and their at-risk older patients were r and omized to either GC or usual care ( UC ) . Six months after baseline , participants rated the quality of their health care by answering vali date d closed-ended questions from telephone interviewers who were masked to group assignment . RESULTS Of the 13,534 older patients screened , 2391 ( 17.7 % ) were eligible to participate in the study , of which 904 ( 37.8 % ) gave informed consent and were cluster-r and omized . After 6 months , 93.8 % and 93.2 % of the GC and UC participants who remained alive and eligible completed telephone interviews . GC participants were more likely than UC participants to rate their care highly ( adjusted odds ratio = 2.0 , 95 % confidence interval , 1.2 - 3.4 , p = .006 ) , and primary care physicians were more likely to be satisfied with their interactions with chronically ill older patients and their families ( p < .05 ) . CONCLUSIONS GC improves important aspects of the quality of health care for multimorbid older persons . Additional data will become available as this trial continues Output:

Explicit attention for goal setting or priority setting by a professional was a common element in these multifactorial interventions . Conclusions Collaborative goal setting and /or priority setting can probably best be integrated in complex care interventions .

MS2_1shot409

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: PURPOSE To investigate whether a combination of self-exp and ing metal stent ( SEMS ) and brachytherapy provided more rapid and prolonged effect on dysphagia without increased pain compared to brachytherapy alone in patients with incurable oesophageal cancer . METHODS 41 Patients were r and omised to SEMS followed by brachytherapy , 8 Gy × 3 ( n=21 ) or brachytherapy alone , 8 Gy × 3 ( n=20 ) . Change in dysphagia and pain three and seven weeks after r and omisation ( FU1 and FU2 ) was assessed by patient-reported outcome . Dysphagia , other symptoms and health-related quality of life were assessed every four weeks thereafter . The study was closed before the estimated patient-number was reached due to slow recruitment . RESULTS Patients receiving SEMS followed by brachytherapy had significantly improved dysphagia at FU1 compared to patients receiving brachytherapy alone ( n=35 ) . Difference in pain was not observed . At FU2 , patients in both arms ( n=21 ) had less dysphagia . Four patients in the combined treatment arm experienced manageable complications , no complications occurred after brachytherapy alone . CONCLUSION For the relief of dysphagia , SEMS followed by brachytherapy is preferable and safe for patients in need of immediate alleviation , while brachytherapy with or without preceding SEMS provides relief within a few weeks after treatment PURPOSE To prospect ively compare the response to treatment with a self-exp and able esophageal stent loaded with iodine 125 ( (125)I ) seeds for intraluminal brachytherapy versus the response to treatment with a conventional self-exp and able covered stent in patients with advanced esophageal cancer . MATERIAL S AND METHODS The study protocol was approved by the institutional ethics committee , and informed consent was obtained from each patient . Patients from one institution who had dysphagia caused by inoperable esophageal cancer were r and omly assigned to receive treatment with a stent loaded with (125)I seeds ( irradiation stent group ) or a conventional covered stent ( control group ) . After stent implantation , the outcomes were measured in terms of relief of dysphagia , survival time , and complications related to the procedure . Dysphagia was assigned a grade . A P value of less than .05 was considered to indicate a significant difference . RESULTS The stent was successfully placed in the diseased esophagus in all 53 patients ( 27 patients in the irradiation stent group and 26 patients in the control group ) . The dysphagia grade s significantly improved in both groups within the 1st month after stent placement but were better in the irradiation stent group than in the control group after 2 months ( P < .05 ) . The median and mean survival times were better in the irradiation stent group than in the control group , and the differences were significant ( P < .001 ) . Hemorrhage occurred in 16 ( 30 % ) patients in both groups combined during follow-up . CONCLUSION In patients with advanced esophageal cancer , treatment with an esophageal stent loaded with (125)I seeds , compared with that with a conventional covered stent , has potential benefit in that it allows a slightly longer relief of dysphagia and extended survival Objective To relieve dysphagia is the main goal in palliative treatment of patients with incurable cancer of the oesophagus or the gastro-oesophageal junction . The aim of this prospect i ve , r and omized multicentre study was to compare stent placement and brachytherapy regarding health economy and clinical outcomes . Methods Patients with incurable cancer of the oesophagus or gastro-oesophageal junction were r and omized to receive a self-exp and able metallic stent or 3 × 7 Gy brachytherapy . At clinical follow-up visits , dysphagia was scored and health care consumptions were recorded . Costs were based on hospital debits . Total lifetime healthcare consumption costs and costs for the initial treatments were calculated and a sensitivity analysis was conducted . Results Thirty patients were r and omized to each treatment group . There was no difference in survival or complication rates between the two treatment strategies . There was a significant difference in the change of dysphagia scores between the time of inclusion and the 1-month follow-up visit , in favour of the stented group ( P=0.03 ) . This difference had disappeared at 3 months . Median total lifetime costs were & U20AC;17 690 for the stented group compared with & U20AC;33 171 for the brachytherapy group ( P=0.005 ) . This difference was due to higher costs for the initial treatment ( & U20AC;4615 versus & U20AC;23 857 , P<0.0001 ) . Sensitivity analyses showed that the charges for a brachytherapy session had to be reduced from & U20AC;6092 to & U20AC;4222 ( 31 % ) to make this therapeutic concept cost-competitive . Conclusion Stenting is currently more cost-effective compared with fractionated 3 × 7 Gy brachytherapy for patients with incurable cancer of the oesophagus and gastro-oesophageal junction Metal stent placement and single dose brachytherapy are commonly used treatment modalities for the palliation of inoperable oesophageal carcinoma . We investigated generic and disease-specific health-related quality of life ( HRQoL ) after these palliative treatments . Patients with dysphagia from inoperable oesophageal carcinoma were r and omised to placement of a covered Ultraflex stent ( n = 108 ) or single dose ( 12 Gy ) brachytherapy ( n = 101 ) . We obtained longitudinal data on disease-specific ( dysphagia score , European Organisation for Research and Treatment of Cancer ( EORTC ) OES-23 , visual analogue pain scale ) and generic ( EORTC Quality of Life-Core 30 Question naire ( QLQ-C30 ) , Euroqol (EQ)-5D ) HRQoL at monthly home visits by a specially-trained research nurse . We compared HRQoL between the two treatments and analysed changes in HRQoL during follow-up . Dysphagia improved more rapidly after stent placement than after brachytherapy , but long-term relief of dysphagia was better after brachytherapy . For generic HRQoL , there was an overall significant difference in favour of brachytherapy on four out of five functional scales of the EORTC QLQ-C30 ( role , emotional , cognitive and social ) ( P < 0.05 ) . Generic HRQoL deteriorated over time on all functional scales of the EORTC QLQ C-30 and EQ-5D , in particular physical and role functioning ( on average -23 and -24 on a 100 points scale during 0.5 years of follow-up ) . This decline was more pronounced in the stent group . Major improvements were seen on the dysphagia and eating scales of the EORTC OES-23 , in contrast to other scales of this disease-specific measure , which remained almost stable during follow-up . Reported levels of chest or abdominal pain remained stable during follow-up in both treatment groups , general pain levels increased to a minor extent . The effects of single dose brachytherapy on HRQoL compared favourably to those of stent placement for the palliation of oesophageal cancer . Future studies on palliative care for oesophageal cancer should at least include generic HRQoL scales , since these were more responsive in measuring patients ' functioning and well-being during follow-up than disease-specific HRQoL scales OBJECTIVE To evaluate the benefits of post-stenting radiotherapy and /or chemotherapy for unresectable esophageal carcinoma . METHODS Fifty-three patients with unresectable esophageal carcinoma were r and omly divided into two groups : patients in group A ( n = 27 ) were treated with stenting alone , and those in group B ( n = 26 ) were treated with stenting followed by radiotherapy and /or chemotherapy . Comparison was made by assessing their survival time , quality of life ( QOL ) , degree of dysphagia , and stenting-related morbidity , respectively . RESULTS There was no statistically significant improvement in dysphagia and QOL between the two groups . Although there was no difference in the frequency of stenting-related complications , re-stenosis occurred much less frequently in group B patients ( P = 0.007 ) . The mean survival time of patients was 245 + /- 41 days and 262 + /- 43 days in group A and group B , respectively . There was no significant difference between the two groups ( P = 0.813 ) . CONCLUSION Besides decreased recurrence of stenosis , post-stenting radiotherapy and /or chemotherapy does not provide additional benefits for survival BACKGROUND Brachytherapy was found to be preferable to metal stent placement for the palliation of dysphagia because of inoperable esophageal cancer in the r and omized SIREC trial . The benefit of brachytherapy , however , only occurred after a relatively long survival . The objective is to develop a model that distinguishes patients with a poor prognosis from those with a relatively good prognosis . METHODS Survival was analyzed with Cox regression analysis . Dysphagia-adjusted survival ( alive with no or mild dysphagia ) was studied with Kaplan-Meier analysis . Patient data is from the multicenter , r and omized , controlled trial ( SIREC , n = 209 ) and a consecutive series ( n = 396 ) . Patients received a stent or single-dose brachytherapy . RESULTS Significant prognostic factors for survival included tumor length , World Health Organization performance score , and the presence of metastases ( multivariable p < 0.001 ) . A simple score , which also included age and gender , could satisfactorily separate patients with a poor , intermediate , and relatively good prognosis within the SIREC trial . For the poor prognosis group , the difference in dysphagia-adjusted survival was 23 days in favor of stent placement compared with brachytherapy ( 77 vs. 54 days , p = 0.16 ) . For the other prognostic groups , brachytherapy result ed in a better dysphagia-adjusted survival . CONCLUSIONS A simple prognostic score may help to identify patients with a poor prognosis in whom stent placement is at least equivalent to brachytherapy . If further vali date d , this score can provide an evidence -based tool for the selection of palliative treatment in esophageal cancer patients Background A majority of patients with esophageal cancer present with inoperable disease and require rapid and long-lasting palliation of dysphagia . Study aim To compare the duration of relief of dysphagia in patients with inoperable esophageal cancer treated with esophageal stenting alone or a combination of esophageal stenting and external beam radiotherapy ( EBRT ) , and to assess overall survival , treatment-related complications , and quality of life ( QOL ) in the two groups . Patients and methods Patients with inoperable esophageal cancer and with high grade dysphagia were r and omized to receive esophageal stenting with self-exp and able metal stent ( Ultraflex ) alone ( Group I ) , versus a combination of stenting followed by EBRT ( 30 gray in ten divided fractions over 2 weeks ) ( Group II ) . Dysphagia relief , overall survival , QOL ( using European Organisation for Research and Treatment of Cancer Quality of Life Question naire-C30 , version 3 ) , and treatment-related complications were assessed in the two groups . Results From April 2007 to March 2009 , 84 patients were r and omized to receive esophageal stent alone ( 42 patients ) or a combination of stent and EBRT ( 42 patients ) . The two groups were comparable in demographics , tumor characteristics , indications for palliative treatment , and pretreatment dysphagia score . Dysphagia scores improved significantly in both groups following stent insertion . However , dysphagia relief was more sustained in Group II than in Group I ( 7 vs. 3 months , p = 0.002 ) . Overall median survival was significantly higher in Group II than in Group I ( 180 vs. 120 days , p = 0.009 ) . Addition of radiotherapy following stenting prolonged the mean dysphagia-free survival ( 118.6 ± 55.8 vs. 96.8 ± 43.0 days , p = 0.054 ) . There was significant improvement in all QOL parameters at 1 week after stenting . The QOL , however , significantly declined immediately after radiotherapy . There was no treatment-related mortality , and the incidence of complications was similar in the two groups . Conclusion Post-stenting EBRT effectively prolongs duration of dysphagia relief and improves overall survival in inoperable esophageal cancer SUMMARY Esophageal cancer often presents as advanced stage disease with a dismal prognosis , with only 10 - 15 % of patients surviving 5 years . Therefore , in a large proportion of patients , palliative treatment is the only option available . The aim of this study was to prospect ively compare the palliative effect of self-exp and able stent placement with that of endoluminal brachytherapy regarding the effect on quality of life and on specific symptoms . Sixty-five patients with advanced cancer of the esophagus or gastroesophageal junction were r and omized to treatment with either an Ultraflex exp and able stent or high-dose-rate endoluminal brachytherapy with 7 Gy x 3 given in 2 - 4 Output:

Stents combination therapy was also associated with a more favorable overall survival . The risks of stent migration , aspiration pneumonia , and restenosis were lower in the stents combination group compared to stents alone , while the risks of severe pain , hemorrhage , and fistula formation were higher . Changes in dysphagia scores and overall survival did not differ significantly in the brachytherapy-alone vs stents-alone comparison . The risk of fistula formation and hemorrhage were higher in the stents-alone group , while the risk of perforation was lower , compared to brachytherapy alone . Quality of life improvements were seen in all treatment groups , but were not pooled in analysis due to differing methods of measurement . Discussion While there appears to be no immediate short-term differences , those who live longer than 3 months experience a significant improvement in dysphagia score using a stents combination therapy approach vs stents alone . The combination therapy significantly improves the overall survival as well as showed improvements in quality of life scores .

MS2_1shot410

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Objective . Determine the association between obstructive sleep apnea ( OSA ) and auditory dysfunction in older subjects . Study Design . Cross-sectional study . Setting . Hospital volunteer helpers undergoing question naire , morphometry measurement , auditory examinations , and polysomnography between 2008 and 2009 . Subjects and Methods . In total , 224 subjects older than 50 years were r and omly sample d for above evaluation and testing . The effects of OSA on the peripheral auditory function , represented by averaged pure-tone threshold of low frequencies ( PTA-low ) and high frequencies ( PTA-high ) , and central auditory function , shown by pitch pattern sequence ( PPS scores ) , were analyzed . Results . The mean ± SD age was 61.2 ± 6.7 years . OSA was confirmed in 6 of 98 women ( 6.1 % ) and 28 of 126 men ( 22.2 % ) . After adjusting for age , gender , and other variables , OSA did not show a significant positive association with PTA-low or PTA-high for all subjects . Conversely , there was a significant negative association between OSA and PPS scores for all subjects , even after adjusting for age , gender , and other variables . When OSA and central obesity together were taken into account in the multivariate linear regression analysis , OSA still showed significant association with PPS score for all subjects . Conclusion . OSA is independently associated with poorer central auditory function in older subjects Abstract Obstructive sleep apnea ( OSA ) is a common disorder , characterized by cyclic cessation of airflow for 10 seconds or more . There is growing awareness that OSA is related to the development and progression of cardiovascular disease . However , only a few studies have associated OSA directly to major cardiovascular events . The aim of this study was to evaluate the relationship between OSA and cardiovascular morbidity in a well defined population of patients .The electronic data base of the central district of a major health management organization was search ed for all patients diagnosed with OSA in 2002–2010 . For each patient identified , an age- and sex-matched patient was r and omly selected from the members of the same health management organization who did not have OSA . Data on demographics , socioeconomic status , and relevant medical parameters were collected as well . The study population included 2797 patients , average age 58.1 , in which 76.6 % were males . There was a significant correlation between OSA and the presence of ischemic heart disease ( P < 0.001 ) , pulmonary hypertension ( P < 0.001 ) , congestive heart failure ( P < 0.001 ) , cardiomyopathy ( P = 0.003 ) , and arrhythmia ( P < 0.001 ) . OSA was also significantly correlated with low socioeconomic status ( P < 0.001).OSA and cardiovascular disease were strongly correlated . As such , early diagnosis and treatment of OSA may change the course of both diseases . We suggest that sleep disordered breathing should be routinely assessed in patients with cardiovascular problems . An ear – nose – throat evaluation may also be important to rule out anatomic disorders that cause upper airway obstruction Background The Berlin Question naire ( BQ ) is a useful tool to identify the high-risk group for obstructive sleep apnea ( OSA ) in the primary care sites or hospital , but the usefulness of the BQ to identify the high-risk group for OSA in the general population has not been evaluated . The purpose of our study was to develop the Korean version of the BQ ( KBQ ) and evaluate the usefulness of the BQ in identifying patients with OSA in the general population . Methods A total of 1,305 subjects were included in a population -based door-to-door cross-sectional study . For validation of the KBQ , an overnight polysomnography ( PSG ) was performed on 101 subjects who were r and omly selected considering their age , sex , and risk group classification at a controlled sleep laboratory . Results The KBQ showed a relatively good to excellent internal consistency ( Cronbach ’s α correlation 0.64–0.78 ) and test – retest reliability ( intraclass correlation 0.92 ) . The apnea – hypopnea index ( AHI ) was significantly correlated with the scores in each category and the total scores of the KBQ . In addition , high risk grouping based on the KBQ predicted an AHI ≥ 5 with a sensitivity of 0.69 and a specificity of 0.83 . According to the risk categorization based on the KBQ , 26.1 % subjects were in the high-risk group for OSA which was similar to the prevalence of OSA in a previous large epidemiological study using PSG in Korea . Conclusion This is the first study to confirm the usefulness of the BQ as a screening tool for OSA by prioritizing subjects at high risk for OSA in the general population STUDY OBJECTIVES Experimental evidence indicates that alcohol use near bedtime may exacerbate sleep disordered breathing ( SDB ) . However , scarce research has examined the relation between moderate habitual alcohol use and objective ly assessed SDB , and it is unclear whether patients with SDB , or those at risk for SDB , should be counseled to avoid alcohol regardless of proximity to bedtime . In this population -based epidemiology study , our objective is to measure the association of SDB with usual alcohol consumption habits . METHODS Men ( N = 775 ) and women ( N = 645)--initially r and omly selected from a working population --participating in the Wisconsin Sleep Cohort Study were evaluated for alcohol consumption and SDB . The apnea-hypopnea index ( AHI , events/hour ) was determined by in-laboratory polysomnography . AHI > 5 defined " mild or worse " SDB and AHI > 15 defined " moderate or worse " SDB . Alcohol consumption ( drinks/day ) was assessed by question naire . Potential confounding or interacting variables such as smoking , body mass index , and medication use , were measured by clinical assessment and question naire . RESULTS Relative to men who consumed less alcohol , for each increment of one drink per day , men who consumed more alcohol had 25 % greater odds of mild or worse SDB ( OR = 1.25 , 95 % CI = 1.07 - 1.46 , p = 0.006 ) . Among women , minimal to moderate alcohol consumption was not significantly associated with increased risk of SDB . DISCUSSION In men , increased usual alcohol consumption was associated with increased risk of mild or worse SDB . Persons with SDB might benefit from generally reduced alcohol consumption and not just avoidance near bedtime OBJECTIVE Obstructive sleep apnea ( OSA ) has been recognized in the Western world as a public health burden , but there has been no community-based study performed to assess the prevalence of the condition in India . The study was performed to assess the prevalence and risk factors of OSA in a semi-urban Indian population . DESIGN A two-stage , cross-sectional , community-based prevalence study . SETTING A semi-urban community in Delhi . DURATION Two years ( 2003 to 2005 ) . PATIENTS AND PARTICIPANTS All citizens residing in the community who were 30 to 60 years of age . Exclusion criteria included those patients with recent myocardial infa rct ion , upper airway surgery , class III/IV congestive heart failure , pregnancy , hypothyroidism on treatment , acromegaly , chronic renal failure , systemic steroid treatment , and hormone replacement therapy . INTERVENTION An OSA assessment was performed in 2,400 subjects who were screened in stage 1 of the study by means of a sleep question naire . Subjects were then divided into habitual and nonhabitual snorers . Eighty-three r and omly selected habitual snorers and 80 nonhabitual snorers were invited to participate in stage 2 of the study , which consisted of in-hospital polysomnography studies . OBSERVATIONS AND RESULTS A total of 2,150 subjects returned question naires ( response rate , 90 % ) . Of 550 habitual snorers and 1,596 nonhabitual snorers , 77 habitual snorers and 73 nonhabitual snorers underwent polysomnography . A total of 36 habitual snorers ( 46.75 % ) and 2 nonhabitual snorers ( 2.73 % ) were found to have OSA , giving prevalence rates of 13.74 % and 3.57 % , respectively , for OSA and OSA syndrome ( OSAS ) on extrapolation . Multivariate analysis revealed that male gender , age , obesity ( defined by a high body mass index ) , and waist/hip ratio as significant risk factors for OSAS . CONCLUSIONS This study demonstrated that the risk factors and prevalence for OSA in India are similar to those in the West , which is contrary to the findings of some previous reports , which had a strong inclusion bias Nasal continuous positive airway pressure ( nasal CPAP ) and polysomnography were used to analyze the time course of the effect of bedtime ethanol on resistance of upper airways and on the number of respiratory pauses during sleep . On one night , six asymptomatic nonalcoholic male snorers drank 2 ml/kg of 100 proof vodka mixed in orange juice ( ethanol dose , 0.79 gm/kg , giving a peak blood alcohol level of 71.8 + /- 33.3 mg/dl ) . On a second night they received a placebo ( 1 - 2 drops of vodka floated on top of the orange juice ) . We measured ( a ) the minimum nasal ( CPAP ) required to eliminate snoring , ( b ) the number of hypopneas and apneas during each hour of sleep and ( c ) the arterial oxygen saturation ( SaO2 ) by ear oximetry . On the alcohol night there was a significant increase in the CPAP pressure required to eliminate snoring ( placebo 4.8 + /- 1.7 cm H2O , alcohol 6.2 + /- 1.5 cm H2O ) . The number of respiratory events per hour of sleep ( apnea index ) was 7.5 + /- 2.1 for ethanol nights versus 3.8 + /- 2.7 for placebo nights ( p less than 0.0125 ) . An apnea index of greater than 5 is generally considered abnormal . There was no significant difference in the number of desaturation events ( declines of 4 % or more in the SaO2 ) or in the mean SaO2 , but the minimum SaO2 was significantly lower on the ethanol night ( placebo 89.8 % + /- 1.6 , alcohol 86.8 % + /- 2.7 , p less than 0.05 ) . The effect of this dose of alcohol on airway resistance was most pronounced during the first 2 hr after ingestion BACKGROUND Sleep-disordered breathing is prevalent in the general population and has been linked to chronically elevated blood pressure in cross-sectional epidemiologic studies . We performed a prospect i ve , population -based study of the association between objective ly measured sleep-disordered breathing and hypertension ( defined as a laboratory-measured blood pressure of at least 140/90 mm Hg or the use of antihypertensive medications ) . METHODS We analyzed data on sleep-disordered breathing , blood pressure , habitus , and health history at base line and after four years of follow-up in 709 participants of the Wisconsin Sleep Cohort Study ( and after eight years of follow-up in the case of 184 of these participants ) . Participants were assessed overnight by 18-channel polysomnography for sleep-disordered breathing , as defined by the apnea-hypopnea index ( the number of episodes of apnea and hypopnea per hour of sleep ) . The odds ratios for the presence of hypertension at the four-year follow-up study according to the apnea-hypopnea index at base line were estimated after adjustment for base-line hypertension status , body-mass index , neck and waist circumference , age , sex , and weekly use of alcohol and cigarettes . RESULTS Relative to the reference category of an apnea-hypopnea index of 0 events per hour at base line , the odds ratios for the presence of hypertension at follow-up were 1.42 ( 95 percent confidence interval , 1.13 to 1.78 ) with an apnea-hypopnea index of 0.1 to 4.9 events per hour at base line as compared with none , 2.03 ( 95 percent confidence interval , 1.29 to 3.17 ) with an apnea-hypopnea index of 5.0 to 14.9 events per hour , and 2.89 ( 95 percent confidence interval , 1.46 to 5.64 ) with an apnea-hypopnea index of 15.0 or more events per hour . CONCLUSIONS We found a dose-response association between sleep-disordered breathing at base line and the presence of hypertension four years later that was independent of known confounding factors . The findings suggest that sleep-disordered breathing is likely to be a risk factor for hypertension and consequent cardiovascular morbidity in the general population Apnea during sleep has been associated with both increased pharyngeal resistance and nasal obstruction . Alcohol can worsen obstructive sleep apnea , but its influence on pharyngeal resistance and nasal patency has not been evaluated . Accordingly , we determined the effects of alcohol on pharyngeal and nasal resistances in 11 normal awake subjects on 2 separate days . Baseline pharyngeal resistance prior to placebo and alcohol was not significantly different . After placebo , pharyngeal resistance did not change significantly . However , after alcohol , pharyngeal resistance increased from 1.9 + /- 0.5 ( SEM ) to Output:

This estimate 's differences were robust in alcohol consumption and sleep apnoea definitions , study design , and quality but was greater in Low and Middle Income Country locations . Conclusion These findings suggest that alcohol consumption is associated with a higher risk of sleep apnoea , further supporting evidence that reducing alcohol intake is of potential therapeutic and preventive value in this condition

MS2_1shot411

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND To examine the impact of a frequent her2 gene polymorphism ( Ile655Val ) on tumor growth and on the pharmacodynamics of treatment by trastuzumab . PATIENTS AND METHODS Experimental study : The growth characteristics of cells expressing the Ile or Val isoform were examined in vitro and after injection into nude mice . The effect of trastuzumab was determined in both experimental models . Clinical study : 61 patients with advanced breast cancers and treated by trastuzumab were genotyped for HER2 by PCR-RFLP . The influence of HER2 genotype on the trastuzumab treatment was examined . RESULTS Experimental study : HER2-expressing cells acquired the characteristics of tumor cells . The Val isoform-expressing cells showed the highest growth capacity and developed aggressive tumors sensitive to trastuzumab . Clinical study : There was no link between tumor response or survival and HER2 genotype . All cases of treatment-related cardiotoxicity were found in the Ile/Val group and there was no cardiac toxicity in the Val/Val and Ile/Ile patients . CONCLUSIONS This study establishes a clear-cut difference between the two HER2 isoforms regarding their tumorogenic potential with an advantage for the Val/HER2 isoform . In breast cancer patients treated with trastuzumab , the presence of a Val allele may constitute a risk factor for cardiac toxicity Abstract The aim of this prospect i ve clinical study is to evaluate the relationship between changes in functional cardiac parameters following anthracycline therapy and carbonyl reductase 3 ( CBR3p . V244 M ) and glutathione S transferase Pi ( GSTP1p . I105V ) polymorphisms . Seventy patients with normal cardiac function and no history of cardiac disease scheduled to undergo anthracycline chemotherapy were included in the study . The patients ’ cardiac function was evaluated by gated blood pool scintigraphy and echocardiography before and after chemotherapy , as well as 1 year following therapy . Gene polymorphisms were genotyped in 70 patients using TaqMan probes , vali date d by DNA sequencing . A deteriorating trend was observed in both systolic and diastolic parameters from GG to AA in CBR3p . V244 M polymorphism . Patients with G-allele carriers of GSTP1p . I105V polymorphism were common ( 60 % ) , with significantly decreased PFR compared to patiens with AA genotype . Variants of CBR3 and GSTP1 enzymes may be associated with changes in short-term functional cardiac parameters BACKGROUND The involvement of iron in anthracycline cardiotoxicity is supported by extensive experimental data , and by the preventive efficacy of dexrazoxane , an iron chelator . However , no clinical evidence of anthracycline-induced cardiac iron accumulation is available and the influence of previous iron overload or of genetic factors in human-induced heart disease is largely unknown . Our aim was to test the hypothesis that anthracyclines increase iron heart concentration and that HFE genotype modulates this iron deposit . METHODS We retrospectively evaluated cardiac events , cardiac iron and HFE genotype in 97 consecutive necropsies from patients with solid and hematological neoplasms . Heart and liver iron concentration was determined by atomic absorption spectroscopy . HFE gene mutations ( C282Y and H63D ) linked to hereditary hemochromatosis were analyzed by Fluorescence Resonance Energy Transfer ( FRET ) genotyping . RESULTS Heart iron concentration was increased in cases treated with a cumulative doxorubicin dose greater than 200mg/m(2 ) ( 490 vs 240 μg/g ; p=0.01 ) , independently of liver iron load or transfusion history . HFE mutated haplotypes 282C/63D ( p=0.049 ) and 282Y/63H ( p=0.027 ) were associated to higher cardiac iron deposits . The haplotype C282Y-Y/H63D-H interacted with anthracyclines for increasing cardiac iron load . In a multivariate linear regression analysis both HFE genotypes and anthracyclines contributed to heart iron concentration ( R(2)=0.284 ) . CONCLUSIONS Our data support the occurrence of an HFE-modulated heart iron accumulation in individuals treated with anthracyclines , independently of systemic iron load . If prospect ively confirmed , iron-related parameters might be useful as predictive factors for anthracycline cardiotoxicity BACKGROUND The use of anthracyclines as effective antineoplastic drugs is limited by the occurrence of cardiotoxicity . Multiple genetic variants predictive of anthracycline-induced cardiotoxicity ( ACT ) in children were recently identified . The current study was aim ed to assess replication of these findings in an independent cohort of children . PROCEDURE . Twenty-three variants were tested for association with ACT in an independent cohort of 218 patients . Predictive models including genetic and clinical risk factors were constructed in the original cohort and assessed in the current replication cohort . RESULTS . We confirmed the association of rs17863783 in UGT1A6 and ACT in the replication cohort ( P = 0.0062 , odds ratio ( OR ) 7.98 ) . Additional evidence for association of rs7853758 ( P = 0.058 , OR 0.46 ) and rs885004 ( P = 0.058 , OR 0.42 ) in SLC28A3 was found ( combined P = 1.6 × 10(-5 ) and P = 3.0 × 10(-5 ) , respectively ) . A previously constructed prediction model did not significantly improve risk prediction in the replication cohort over clinical factors alone . However , an improved prediction model constructed using replicated genetic variants as well as clinical factors discriminated significantly better between cases and controls than clinical factors alone in both original ( AUC 0.77 vs. 0.68 , P = 0.0031 ) and replication cohort ( AUC 0.77 vs. 0.69 , P = 0.060 ) . CONCLUSIONS . We vali date d genetic variants in two genes predictive of ACT in an independent cohort . A prediction model combining replicated genetic variants as well as clinical risk factors might be able to identify high- and low-risk patients who could benefit from alternative treatment options Background Anthracyclines are important chemotherapeutic agents , but their use is limited by cardiotoxicity . C and i date gene and genome-wide studies have identified putative risk loci for overt cardiotoxicity and heart failure , but there has been no comprehensive assessment of genomic variation influencing the intermediate phenotype of anthracycline-related changes in left ventricular ( LV ) function . The purpose of this study was to identify genetic factors influencing changes in LV function after anthracycline chemotherapy . Methods We conducted a genome-wide association study ( GWAS ) of change in LV function after anthracycline exposure in 385 patients identified from BioVU , a re source linking DNA sample s to de-identified electronic medical record data . Variants with P values less than 1 × 10−5 were independently tested for replication in a cohort of 181 anthracycline-exposed patients from a prospect i ve clinical trial . Pathway analysis was performed to assess combined effects of multiple genetic variants . Results Both cohorts were middle-aged adults of predominantly European descent . Among 11 c and i date loci identified in discovery GWAS , one single nucleotide polymorphism near PR domain containing 2 , with ZNF domain ( PRDM2 ) , rs7542939 , had a combined P value of 6.5 × 10−7 in meta- analysis . Eighteen Kyoto Encyclopedia of Gene and Genomes pathways showed strong enrichment for variants associated with the primary outcome . Identified pathways related to DNA repair , cellular metabolism , and cardiac remodeling . Conclusion Using genome-wide association we identified a novel c and i date susceptibility locus near PRDM2 . Variation in genes belonging to pathways related to DNA repair , metabolism , and cardiac remodeling may influence changes in LV function after anthracycline exposure PURPOSE This study sought to estimate cardiac dysfunction ( CD ) risk for patients receiving trastuzumab ; to characterize observed CD by severity , treatment , and clinical outcome ; to assess effects of baseline clinical risk factors on CD ; and to assess effects of cumulative doses of anthracyclines and trastuzumab on CD . PATIENTS AND METHODS A retrospective review of records for patients enrolled onto any of seven phase II and III trastuzumab clinical trials was performed . Predefined criteria were used for the diagnosis , and the New York Heart Association functional classification system was used to document CD severity . Product-limit estimates were used to summarize the cumulative anthracycline and trastuzumab doses at the time of CD onset . RESULTS Patients treated with trastuzumab were found to be at an increased risk for CD . The incidence was greatest in patients receiving concomitant trastuzumab and anthracycline plus cyclophosphamide ( 27 % ) . The risk was substantially lower in patients receiving paclitaxel and trastuzumab ( 13 % ) or trastuzumab alone ( 3 % to 7 % ) ; however , most of these patients had received prior anthracycline therapy . CD was noted in 8 % of patients receiving anthracycline plus cyclophosphamide and 1 % receiving paclitaxel alone . Most trastuzumab-treated patients developing CD were symptomatic ( 75 % ) , and most improved with st and ard treatment for congestive heart failure ( 79 % ) . CONCLUSION Trastuzumab is associated with an increased risk of CD , which is greatest in patients receiving concurrent anthracyclines . In most patients with metastatic breast cancer , the risk of CD can be justified given the improvement in overall survival previously reported with trastuzumab The purpose of this study was to investigate , in the context of a prospect i ve node-positive-breast cancer trial HER2 containing-regimen ( UNICANCER-PACS 04 trial ) , the predictive value of HER2 , FCGRIIA , and FCGRIIIA gene polymorphisms for cardiac toxicity and efficacy of trastuzumab . We analyzed HER2–I655V , FCGR2A – H131R , and FCGR3A – V158F single nucleotide polymorphisms in patients in adjuvant setting treated by six courses of either fluorouracil 500 mg/m2 , epirubicin 100 mg/m2 and cyclophosphamide 500 mg/m2 , or epirubicin 75 mg/m2 and docetaxel 75 mg/m2 every 3 weeks then r and omly assigned , in case of HER2 overexpressing tumor , to either trastuzumab for 1 year or nothing . Left ventricular ejection fraction and clinical examination were monitored in each patient , seven times throughout the study to detect congestive heart failure or asymptomatic sub clinical cardiac toxicity . All genotypes were analyzed in relation to cardiac toxicity , EFS , and OS . One hundred and thirty-two HER2-positive breast cancer patients were analyzed . The HER2–I655V genotype was significantly associated with cardiac toxicity ( p = 0.025 ) . The FCGR2A-131 H/H genotype was significantly correlated with a shorter EFS ( p = 0.027 ) . The FCGR3A-158 V/V genotype was not correlated with EFS nor OS . These results might be useful in making a treatment choice of HER2 blockers in adjuvant setting by with an increase in efficacy and decrease in toxicity IMPORTANCE This is the first r and omized placebo-controlled evaluation of a medical intervention for the prevention of trastuzumab-related cardiotoxic effects . OBJECTIVE To determine as the primary end point whether angiotensin II antagonist treatment with c and esartan can prevent or ameliorate trastuzumab-related cardiotoxic effects , defined as a decline in left ventricular ejection fraction ( LVEF ) of more than 15 % or a decrease below the absolute value 45 % . DESIGN This r and omized , placebo-controlled clinical study was conducted between October 2007 and October 2011 in 19 hospitals in the Netherl and s , enrolling 210 women with early breast cancer testing positive for human epidermal growth factor receptor 2 ( HER2 ) who were being considered for adjuvant systemic treatment with anthracycline-containing chemotherapy followed by trastuzumab . INTERVENTIONS A total of 78 weeks of c and esartan ( 32 mg/d ) or placebo treatment ; study treatment started at the same day as the first trastuzumab administration and continued until 26 weeks after completion of trastuzumab treatment . MAIN OUTCOMES AND MEASURES The primary outcome was LVEF . Secondary end points included whether the N-terminal of the prohormone brain natriuretic peptide ( NT-proBNP ) and high-sensitivity troponin T ( hs-TnT ) can be used as surrogate markers and whether genetic variability in germline ERBB2 ( formerly HER2 or HER2/neu ) correlates with trastuzumab-related cardiotoxic effects . RESULTS A total of 206 participants were evaluable ( mean age , 49 years ; age range , 25 - 69 years ) 103 in the c and esartan group ( mean age , 50 years ; age range , 25 - 69 years ) and 103 in the placebo group ( mean age , 50 years ; age range , 30 - 67 years ) . Of these , 36 manifested Output:

Existing evidence supports the hypothesis that genetic variation contributes to chemotherapy-related cardiac dysfunction .

MS2_1shot412

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: OBJECTIVES This study evaluated the effectiveness ( changes in health behaviors , health status , and health service utilization ) of a self-management program for chronic disease design ed for use with a heterogeneous group of chronic disease patients . It also explored the differential effectiveness of the intervention for subjects with specific diseases and comorbidities . METHODS The study was a six-month r and omized , controlled trial at community-based sites comparing treatment subjects with wait-list control subjects . Participants were 952 patients 40 years of age or older with a physician-confirmed diagnosis of heart disease , lung disease , stroke , or arthritis . Health behaviors , health status , and health service utilization , as determined by mailed , self-administered question naires , were measured . RESULTS Treatment subjects , when compared with control subjects , demonstrated improvements at 6 months in weekly minutes of exercise , frequency of cognitive symptom management , communication with physicians , self-reported health , health distress , fatigue , disability , and social/role activities limitations . They also had fewer hospitalizations and days in the hospital . No differences were found in pain/physical discomfort , shortness of breath , or psychological well-being . CONCLUSIONS An intervention design ed specifically to meet the needs of a heterogeneous group of chronic disease patients , including those with comorbid conditions , was feasible and beneficial beyond usual care in terms of improved health behaviors and health status . It also result ed in fewer hospitalizations and days of hospitalization OBJECTIVE To assess the efficacy of physical activity promotion in primary care office setting s. DESIGN Systematic review of clinical trials in which the efficacy of physical activity promotion was investigated in a primary care office setting with at least one month of follow up . SUBJECTS A total of 13,981 adults , aged 17 - 85 + , were included from 203 practice s in eight trials assessing physical activity promotion in primary care office setting s. MAIN OUTCOME MEASURES Odds ratios and 95 % confidence intervals were calculated comparing the number of participants who increased their physical activity or were active at follow up in the intervention group with a control group for each study . RESULTS Five of eight trials where positive with statistically significant results ( range 0.91 - 6.56 ) , but significant biases or limited clinical relevance of the outcomes were found in all trials . Short term trials of less than one year ( four of four were positive ) , single-risk-factor trials ( three of three were positive ) , r and omised clinical trials ( two of three were positive ) , and those assessing moderate levels of physical activity ( three of four were positive ) were most likely to find benefit . Only one of four trials lasting longer than a year were positive . CONCLUSION There is limited evidence from well design ed trials that office based physical activity promotion in primary care setting s is efficacious in promoting changes in physical activity that could conceivably have lasting clinical benefits We performed a r and omized controlled trial to evaluate the effectiveness of a patient education and health promotion program in the treatment of Parkinson 's disease . The health promotion program ( PROPATH ) was design ed to improve health confidence , provide information and support , improve physical function through exercise , and work with the physician to optimize medical treatment and compliance . The intervention was delivered by mail , with disease assessment question naires completed by patient or caregiver at 0 , 2 , 4 , and 6 months , with computer-generated reports and individualized recommendation letters returned to patients and reports to physicians . Two hundred ninety patients completed the 6-month trial , 140 patients in the intervention group and 150 in a control group of patients who received only question naires . The intervention group had significantly increased exercise , decreased " time off " and percentage of time off , reduced side effects , and decreased summary Parkinson 's scores by approximately 10 % ( P > 0.05 ) . Twelve of 13 variables showed differences favoring the intervention group . The rate of progression of summary scores became essentially flat during the program for the intervention group and continued to rise sharply for controls ( P > 0.01 ) . Levodopa dose rose for controls and slightly decreased for the intervention group . Doctor visits , hospital days , and sick days were reduced in the intervention group . The quality -of-life assessment demonstrated improvement in patient global , self-efficacy scores , and spouse or caregiver assessment s. We conclude that a low-cost patient education program provides a useful adjunct to medical therapy of Parkinson 's disease , may reduce costs , and can improve intermediate term outcomes BACKGROUND The U.S. Congress m and ated evaluations , initiated in 1989 , to determine whether extending Medicare benefits to include preventive services would improve health status , reduce costs of care , and improve health risk behaviors of beneficiaries . METHODS The Johns Hopkins Medicare Preventive Services Demonstration was a r and omized trial in which Medicare beneficiaries were assigned either to an intervention group that was offered yearly preventive visits for 2 years and optional counseling visits to their primary care provider or to a control group that received usual care . This report describes the effect of the intervention over a period of 2 years on smoking , problem alcohol use , and sedentary lifestyle . RESULTS Differences were observed between the intervention and control groups in the extent to which changes occurred in smoking and problem alcohol use , but none of the differences was statistically significant . The proportion of smokers who quit was higher in the intervention group than in the control group ( 24.2 vs 17.9 % , P = 0.09 ) . However , a higher proportion of problem drinkers in the control group improved ( 67.1 vs 57.0 % , P = 0.183 ) . There was virtually no difference between the intervention and the control groups in the proportion with improvement in sedentary lifestyle . CONCLUSIONS This study demonstrates the difficulty of bringing about health behavior change in older patients in the course of a yearly preventive visit for 2 years with their primary care physician when the visit encompasses screening and immunizations , as well as health behavior counseling directed by the physician . Further study is required to determine whether a more intense program of counseling for health behavior change among older persons by their primary care providers would be effective Abstract Objectives : To establish the effect of an educational intervention for general practitioners on the health behaviours and wellbeing of elderly patients . Design : R and omised controlled trial with 1 year follow up . Setting : Metropolitan general practice s in Melbourne , Australia . Subjects : 42 general practitioners and 267 of their patients aged over 65 years . Intervention : Educational and clinical practice audit programme for general practitioners on health promotion for elderly people . Main outcome measures : Patients ' physical activity , functional status , self rated health , immunisation status , social contacts , psychological wellbeing , drug usage , and rate of influenza vaccination . Primary efficacy variables were changes in outcome measures over 1 year period . Results : Patients in the intervention group had increased ( a ) walking by an average of 88 minutes per fortnight , ( b ) frequency of pleasurable activities , and ( c ) self rated health compared with the control group . No change was seen in drug usage , rate of influenza vaccination , functional status , or psychological wellbeing as a result of the intervention . Extrapolations of the known effect of these changes in behaviour suggest mortality could be reduced by 22 % if activity was sustained for 5 years . Conclusions : Education of the general practitioners had a positive effect on health outcomes of their elderly patients . General practitioners may have considerable public health impact in promotion of health for elderly patients . Key messages Few educational interventions for doctors have shown benefit to the health of patients Elderly people were identified in the UK health initiatives as in need of additional attention , and levels of health protective behaviours were low in community surveys A multifaceted educational intervention for general practitioners was effective in improving walking behaviour , self rated health status , and the frequency of social contacts in elderly patients General practitioners are effective in improving health and health behaviours in their elderly The medical care system is not very effective in modifying health behavior of individuals , in particular , ensuring patient compliance with medication regimens , healthy diets , regular physical activity , and regular health screening , and in the avoidance of substance abuse . Telephone-Linked Care ( TLC ) is a telecommunications technology that enables computer-controlled telephone counseling with patients in their homes . It has been applied to the task of improving a number of different health behaviors . R and omized controlled studies suggest that use of the system for as little as 3 months is associated with improvement in adherence to medication regimens , dietary change in hypercholesterolemia , and increased physical activity among sedentary individuals . Future work involves applying the technology to other important health behaviors , optimally using health behavior theory in the system design , targeting use of TLC to the most appropriate patient groups , incorporating new computer and telecommunications technology into the system , and interfacing TLC into the health care delivery system This study investigated the aerobic fitness , body composition , spirometric variables , Human Activity Profile , and level of adherence to physical activity subsequent to completion of a progressive walking program of six month 's duration ( T1 ) . Sixty-six women previously r and omized to training ( TG ) and control ( CG ) groups were reassessed six months after finishing the six month walking program ( T2 ) . During the follow-up period , 77.8 % of the TG subjects continued with exercise and maintained lower ( p < 0.005 ) exercise heart rates compared to the CG . A Mann-Whitney U test on the difference scores ( T2-T1 ) revealed no difference ( p > 0.05 ) between the TG and CG for changes in Maximum Current Activity and Normative Impairment Index , which are both components of the Human Activity Profile , with the earlier increases ( p < 0.05 ) in these parameters by the TG having been maintained . Participation in a previous low frequency training regimen therefore result ed in elderly women adopting and sustaining a higher level of habitual physical activity . This is important because a favorable modification of lifestyle factors is likely to be indicative of an enhanced outlook for independence This study examines the longitudinal ( 48 months ) effects of a preventive services intervention trial with Medicare beneficiaries . The health promotion intervention incorporated a series of workshops and targeted individualized counseling dealing primarily with nutrition and exercise . All subjects completed a health risk appraisal ( HRA ) question naire , which served as a dependent measure . Results show significant , positive changes in intervention subjects in two activity outcomes , aerobic activity and stretching exercises . Although previous research on this cohort found significant positive changes in nutrition behaviors at 12-month follow-up , these differences were not sustained over the three-year follow-up period . The results offer encouragement that continued research on health promotion will eventually produce protocol s for select activities that will improve the status of seniors ' health BACKGROUND Although inactivity is an important contributor to impaired functioning and disability with age , little is known concerning how improvements in physical functioning and well-being in older adults vary with the type of physical activity undertaken . METHODS One hundred three adults age 65 years and older , recruited via population -based methods , were r and omized to 12 months of community-based , moderate-intensity endurance and strengthening exercises ( Fit & Firm ) or stretching and flexibility exercises ( Stretch & Flex ) . A combination of class- and home-based exercise formats was used . Measured and self-rated physical performance along with perceived functioning and well-being were assessed pre- and postintervention . RESULTS Fit & Firm subjects showed greater 12-month improvements in both measured and self-rated endurance and strength compared to Stretch & Flex subjects . Stretch & Flex subjects reported greater improvements in bodily pain , and Stretch & Flex men evidence d greater improvements in flexibility relative to Fit & Firm subjects . Although overall exercise adherence was high in both exercise conditions ( approximately 80 % ) , subjects in both conditions showed better adherence to the home- versus class-based portions of their exercise prescriptions . CONCLUSIONS Community-based programs focusing on moderate-intensity endurance and strengthening exercises or flexibility exercises can be delivered through a combination of formats that result in improvement in important functional and well-being outcomes . This represents one of the first studies to report significant improvements in an important quality of life outcome -bodily pain-with a regular regimen of stretching and flexibility exercises in a community-based sample of older adults OBJECTIVE To determine whether gains in functioning observed immediately following participation in an 8-week program of supervised fitness walking for patients with knee osteoarthritis were sustained at 1-year followup . METHODS Twenty-nine ( 61.1 % ) of 47 original intervention program patients and 23 ( 51.1 % ) of 45 original control patients were interviewed by telephone at 1-year followup . Patients completed the Arthritis Impact Measurement Scales physical activity , arthritis impact , pain , medication use , and general health perceptions subscales , as well as a separate visual analog pain scale and measures of perceived self-efficacy to cope with arthritis pain and other symptoms . RESULTS Adherence to walking was low , and there were no statistically significant differences between intervention and control patients at one year . CONCLUSIONS The failure of intervention patients to maintain regular walking result ed in loss of functional benefits that were observed at 8 weeks in the original study . Long-term adherence to walking is critical to maintenance of initial gains in functional outcomes Higher levels of physical activity are associated with lower risk of cardiovascular disease . There is growing evidence that the development of the atherosclerotic plaque is associated with inflammation . In this study , the authors investigated the cross-sectional association between physical activity and markers of inflammation in a healthy elderly population . Data obtained in 1989 - 1990 and 1992 - 1993 from the Cardiovascular Health Study , a cohort of 5,888 men and women aged > /=65 years , were analyzed . Concentrations of the inflammation markers-C-reactive protein , fibrinogen , Factor VIII activity , white blood cells , and albumin-were compared cross-sectionally by quartile of self-reported physical activity . Compared with persons in the lowest quartile , those in the highest quart Output:

A wide variety of intervention strategies were reported . The most common interventions were self-monitoring , general health education , goal setting , supervised center-based exercise , problem solving , feedback , reinforcement , and relapse prevention education . Common method ological weaknesses included small sample s , untested outcome measures , and time-limited longitudinal design s. Significant numbers of aging adults increased their physical activity in response to experimental interventions . The amount of increased activity rarely equaled accepted behavior st and ards to achieve positive health outcomes .

MS2_1shot413

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: The authors evaluated a six-session interactive computer cognitive-behavioral treatment program given to volunteer patients who met Research Diagnostic Criteria ( RDC ) for major or minor depressive disorder . Patients were r and omly assigned to computer-administered cognitive-behavioral treatment , to therapist-administered cognitive-behavioral treatment , or to a waiting-list control condition . After treatment and at 2-month follow-up , both treatment groups had improved significantly more than control subjects in their scores on the Beck Depression Inventory , SCL-90-R depression and global scales , Hamilton Rating Scale for Depression , and Automatic Thoughts Question naire . The treatment groups did not differ from each other at either time OBJECTIVE To design a treatment manual and adherence measure for attachment-based family therapy ( ABFT ) for adolescent depression and to collect pilot data on the treatment 's efficacy . METHOD Over a period of 2 years , 32 adolescents meeting criteria for major depressive disorder ( MDD ) were r and omly assigned to 12 weeks of ABFT or a 6-week , minimal-contact , waitlist control group . The sample was 78 % female and 69 % African American ; 69 % were from low-income , inner-city communities . RESULTS At post-treatment , 81 % of the patients treated with ABFT no longer met criteria for MDD , in contrast with 47 % of patients in the waitlist group . Mixed factorial analyses of variance revealed that , compared with the waitlist group , patients treated with ABFT showed a significantly greater reduction in both depressive and anxiety symptoms and family conflict . Of the 15 treated cases assessed at the follow-up , 13 patients ( 87 % ) continued to not meet criteria for MDD 6 months after treatment ended . CONCLUSIONS ABFT appears to be a promising treatment and worthy of further development Les auteurs ont trouve une efficacite semblable pour la therapie cognitivo-comportementale et pour la relaxation , dans le traitement de la depression chez In this study , the authors examined prospect ively the 24-month natural course of remission from major depressive disorder ( MDD ) as a function of personality disorder ( PD ) comorbidity . In 302 participants ( 196 women , 106 men ) , psychiatric and PDs were assessed at baseline with diagnostic interviews , and the course of MDD was assessed with the Longitudinal Interval Follow-Up Evaluation at 6- , 12- , and 24-month follow-ups . Survival analyses revealed an overall 24-month remission rate of 73.5 % for MDD that differed little by gender . Participants with MDD who had certain forms of coexisting PD psychopathology ( schizotypal , borderline , or avoidant ) as their primary PD diagnoses had a significantly longer time to remission from MDD than did patients with MDD without any PD . These PDs emerged as robust predictors of slowed remission from MDD even when controlling for other negative prognostic predictors OBJECTIVE The purpose of this study was to assess the differences between early ( EDs ) , late drop-outs ( LDs ) and completers in the continuation phase of a clinical trial . METHODS The authors studied 119 out patients who were treatment responders in an 8-week open trial with fluoxetine 20 mg/day , and who were then enrolled in a 26-week clinical trial comparing the efficacy of fluoxetine versus fluoxetine and cognitive behavior therapy ( CBT ) . Patients were assessed using the Structured Clinical Interview for DSM-III-R-Axis I ( SCID-Patient Edition ) , Hamilton Depression Rating Scale ( HAMD-17 ) and the following self-rated scales : Beck Depression Inventory ( BDI ) , Beck Hopelessness Scale ( BHS ) , Anxiety Sensitivity Index ( ASI ) and the Symptom Question naire ( SQ ) prior to starting the 26-week continuation phase . We defined ' EDs ' as patients who dropped out either at or prior to Visit 2 ( which was at 2 months into the 6-month continuation phase ) ; those dropping out at Visit 3 or later were defined as ' LDs ' ( ED < or = 2 months and LD > 2 months ) . The Kruskal-Wallis and the Mann-Whitney U tests were used for data analysis . RESULTS Of the 119 out patients , 83 were completers ( mean age : 42.1 + /- 9.0 years , 46 [ 55 % ] women , age of onset of major depressive disorder [ MDD ] = 24.3 + /- 12.5 years ) , 11 were EDs ( mean age : 38.1 + /- 13.0 years , 4 [ 36 % ] women , age of onset of MDD = 22.0 + /- 11.1 years ) and 25 were LDs ( mean age : 35.2 + /- 10.4 years , 12 [ 48 % ] women , age of onset of MDD = 24.6 + /- 11.6 years ) . LDs were significantly younger than completers ( P<.01 ) . There was no significant difference in age between EDs and LDs , nor between EDs and completers . EDs and completers were depressed for a longer period of time compared to LDs ( P<.05 ) . EDs also had significantly greater overall impairment in social adjustment compared to completers ( P<.05 ) . CONCLUSIONS Our data suggest that LDs are significantly younger than completers , although age is not a predictor between EDs and LDs . Further , EDs and completers are depressed for a longer duration than LDs , and EDs have significantly greater social impairment compared to completers . Our study identified some patient characteristics significantly associated with dropping out of a long-term clinical trial OBJECTIVE This paper presents retrospective and prospect i ve data regarding time course parameters of major depressive disorder ( MDD ) in community adolescents ( 14 to 18 years old ) : time to onset and recovery and , among those who recovered , time to recurrence . METHOD Diagnostic interviews were conducted with 1,508 r and omly selected high school students . Three hundred sixty-two had experienced at least one past or current episode of MDD . RESULTS Mean age at onset of first episode was 14.9 ( SD = 2.8 ) . Early MDD onset was associated with female gender and suicidal ideation . MDD episode duration ranged from 2 to 520 weeks , with a mean of 26.4 weeks ( SE = 3.3 ) and a median of 8.0 weeks . Longer episodes were observed in those whose depression occurred early ( at or before age 15 ) , whose depression had been accompanied by suicidal ideation , and for whom treatment was sought . Of the adolescents who recovered , 5 % relapsed within 6 months , 12 % within 1 year , and approximately 33 % within 4 years . Shorter time to recurrence was associated with prior suicidal ideation and attempt and with later first onset . CONCLUSIONS Risk of MDD is low in childhood , increasing substantially with adolescence . The majority of episodes in community adolescents are relatively brief , although the risk of recurrence is substantial . Suicidal behaviors are important mediators of episode duration and of recurrence The objectives of the present report were : a ) to determine the spontaneous remission rate in depressed out patients who do not receive antidepressant medication ; b ) to develop a novel method for obtaining a control group that can be used to gauge the effectiveness of antidepressant medication in clinical practice ; and c ) to compare response rates from the present sample with outcomes of depressed patients in our practice who were treated with antidepressant medications . By using a naturalistic design , prospect i ve assessment s were made on all depressed out patients . Twenty-five patients who met full criteria for a major depressive episode ended up not taking antidepressant medication for a variety of reasons . " Response " rates to a no-treatment trial were determined with st and ard outcome criteria using the Clinical Global Impression-Improvement scale . Eight patients ( 32.0 % ) had a positive response , 5 patients ( 20.0 % ) had a partial response , and 12 patients ( 48.0 % ) were nonresponders to a no-treatment trial . These response rates were higher than expected , but significantly lower than what we had found in a cohort of depressed patients who underwent an antidepressant trial ( p = .02 ) . Likewise , treatment-resistant patients fared better on pharmacotherapy , though this difference was not statistically significant . These results suggest that the occurrence of spontaneous remissions may be common in clinical practice , and therefore the specific short-term benefits of antidepressant medication in clinical practice may frequently be overestimated . Despite the high rate of spontaneous remission in our sample , the present study allowed us to confirm the effectiveness of antidepressant medication in clinical practice using a novel method for obtaining a control comparison group Compared the effects of 2 psychotherapies based on divergent conceptualizations of depression in later life . Seventy-five older adults diagnosed with major depressive disorder were assigned r and omly to problem-solving therapy ( PST ) , reminiscence therapy ( RT ) , or a waiting-list control ( WLC ) condition . Participants in PST and RT were provided with 12 weekly sessions of group treatment . Dependent measures , taken at baseline , posttreatment , and 3-month follow-up , included self-report and observer-based assessment s of depressive symptomatology . At posttreatment , both the PST and the RT conditions produced significant reductions in depressive symptoms , compared with the WLC group , and PST participants experienced significantly less depression than RT subjects . Moreover , a significantly greater proportion of participants in PST versus RT demonstrated sufficient positive change to warrant classification of their depression as improved or in remission at the posttreatment and follow-up evaluations Elementary school children with mild-to-moderate depressive symptoms were r and omly assigned to a control group or an 8-session Primary and Secondary Control Enhancement Training program . The program focused on ( a ) primary control ( changing objective conditions to fit one 's wishes ; e.g. , through activity selection and goal attainment ) and ( b ) secondary control ( changing oneself to buffer the impact of objective conditions ; e.g. , altering depressogenic thinking , practicing mood-enhancing cognitions ) . At immediate posttreatment and 9-month follow-up , the treatment group showed greater reductions than the control group in depressive symptomatology on the Children 's Depression Inventory and the Revised Children 's Depression Rating Scale , and treated children , more than controls , shifted from above to within the normal range on both measures . Future research is needed to test treatment effects with severely depressed youths BACKGROUND We evaluated the long-term outcome of depression and anxiety and associated disability among primary -care attenders with common psychiatric disorders and symptoms ( n = 201 ) using binary and multicategorical , interview-based outcome measures of psychiatric illness and disability . METHODS A two-stage design was used . In the first stage , 1994 consecutive attenders of 25 general practitioners were screened on psychiatric illness with the General Health Question naire and by their physicians . A stratified r and om sample ( n = 292 ) with differing probabilities was selected for second-stage interview ( Present State Examination and Groningen Disability Schedule ) . Patients with psychiatric symptoms ( n = 201 ) were reassessed 1 ( n = 182 ) and 3 1/2 ( n = 154 ) years later . RESULTS At 1- and 3 1/2-year follow-ups , many cases no longer met the criteria of their baseline diagnosis and disability levels had substantially dropped . However , partial remission , not full recovery , was the rule , and was associated with residual disability . Depression had better outcomes than anxiety and mixed anxiety-depression . CONCLUSIONS We concluded that a multicategorical , rather than a binary , outcome measure better reflects patient outcomes , since it highlights partial remission , mild symptoms , and residual disability , and as such , stresses the need to supplement short-term treatment . A multicategorical caseness model may be advantageous for research and clinical practice . We suggest a dynamic-equilibrium model to account for residual symptoms and disability . This study is a follow-up to two earlier reports on the recognition , treatment , and 1-year course of common psychiatric illnesses in general practice The goal of the study was to describe the naturalistic course of unipolar major depression in subjects not receiving somatic therapy for their depressive illness . Affectively ill individuals were recruited into the Collaborative Depression Study and followed prospect ively for up to 15 years . One hundred thirty subjects who recovered from their intake episode of major depression subsequently experienced a recurrence that went untreated for at least 4 weeks following onset of the recurrence . The duration of the recurrent episode was examined using survival analytic techniques . Of the 130 subjects , 46 obtained somatic therapy at some time during the course of their depressive illness , while 84 subjects received no somatic therapy throughout their entire depressive episode . Survival analysis , which accounts for these 46 individuals by censoring their episodes at the time treatment was obtained , yielded a median time to recovery of 23 weeks . In the sub sample of 84 subjects whose depressive illness went untreated from its inception through its resolution , the median time to recovery was 13 weeks . These results suggest that there is a high rate of recovery in individuals not receiving somatic treatment of their depressive illness , particularly in the first 3 months of an episode . Because treatment-seeking behavior is known to be associated with a worse prognosis , 23 weeks probably represents a lower-limit approximation of the median duration of an untreated depressive episode OBJECTIVE This trial examined the effects of both acute and maintenance cognitive-behavioral therapy ( CBT ) for depressed adolescents Output:

It is undesirable to expect 100 % treatment coverage for depression , given many will remit before access to services is feasible . Considering reported rates of spontaneous remission , a short untreated period seems defensible for this sub population , where judged appropriate by the clinician . Conclusions may not apply to individuals with more severe depression

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***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Objective : The aim of this study was to assess the reduction in the incidence of parastomal hernia ( PH ) after placement of prophylactic synthetic mesh using a modified Sugarbaker technique when a permanent end-colostomy is needed . Summary of Background Data : Prevention of PH formation is crucial given the high prevalence of PH and difficulties in the surgical repair of PH . Methods : A r and omized , prospect i ve , double-blind , and controlled trial . Rectal cancer patients undergoing laparoscopic abdominoperineal resection with permanent colostomy were r and omized ( 1 : 1 ) to the mesh and nonmesh arms . In the mesh group , a large-pore lightweight composite mesh was placed in the intraperitoneal/onlay fashion using a modified Sugarbaker technique . PH was detected by computed tomography ( CT ) after a minimum follow-up of 12 months . Analysis was per- protocol . Results : The mesh group included 24 patients and the control group 28 . Preoperative data , surgical time , and postoperative morbidity were similar . The median follow-up was 26 months . After CT examination , 6 of 24 PHs ( 25 % ) were observed in the mesh group compared with 18 of 28 ( 64.3 % ) in the nonmesh group ( odds ratio 0.39 , 95 % confidence interval 0.18–0.82 ; P = 0.005 ) . The Kaplan-Meier curves showed significant differences in favor of the mesh group ( long-rank = 4.21 , P = 0.04 ) . The number needed to treat was 2.5 , which confirmed the effectiveness of the intervention . Conclusions : Placement of a prosthetic mesh by the laparoscopic approach following the modified Sugarbaker technique is safe and effective in the prevention of PH , reducing significantly the incidence of PH Purpose Parastomal hernia ( PSH ) is a common complication after colostomy formation . Recent studies indicate that mesh implantation during formation of a colostomy might prevent a PSH . To determine if placement of a retromuscular mesh at the colostomy site is a feasible , safe and effective procedure in preventing a parastomal hernia , we performed a multicentre r and omized controlled trial in 11 large teaching hospitals and three university centres in The Netherl and s. Methods Augmentation of the abdominal wall with a retromuscular light-weight polypropylene mesh ( Parietene Light ™ , Covidien ) around the trephine was compared with traditional colostomy formation . Patients undergoing elective open formation of a permanent end-colostomy were eligible . 150 patients were r and omized between 2010 and 2012 . Primary endpoint of the PREVENT trial is the incidence of parastomal hernia . Secondary endpoints are morbidity , pain , quality of life , mortality and cost-effectiveness . This article focussed on the early results of the PREVENT trial and , therefore , operation time , postoperative morbidity , pain , and quality of life were measured . Results Outcomes represent results after 3 months of follow-up . A total of 150 patients were r and omized . Mean operation time of the mesh group ( N = 72 ) was significantly longer than in the control group ( N = 78 ) ( 182.6 vs. 156.8 min ; P = 0.018 ) . Four ( 2.7 % ) peristomal infections occurred of which one ( 1.4 % ) in the mesh group . No infection of the mesh occurred . Most of the other infections were infections of the perineal wound , equally distributed over both groups . No statistical differences were discovered in stoma or mesh-related complications , fistula or stricture formation , pain , or quality of life . Conclusions During open and elective formation of an end-colostomy , primary placement of a retromuscular light-weight polypropylene mesh for prevention of a parastomal hernia is a safe and feasible procedure . The PREVENT trial is registered at : http://www.trialregister.nl/trialreg/admin/ rct view.asp?TC=2018 Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background Parastomal hernias ( PH ) are frequent with a high morbidity . Three r and omised controlled trials have shown that prophylactic mesh stoma reinforcement significantly reduces their incidence . Implantation and fixation of mesh can be time-consuming , difficult to perform laparoscopically and does not deal with the excessive stretching of the trephine and the creation of an oversized defect . The Stapled Mesh stomAReinforcement Technique ( SMART ) obviates these technical problems . The aim of this study was to assess the safety and efficacy of a novel surgical technique called SMART in preventing parastomal herniation . MethodS MART uses a purpose design ed circular stapling gun ( Compact ™ , Frankenman International Limited ) of various diameters to create a precise trephine and simultaneously fixes a mesh sub-peritoneally and circumferentially to the trephine . Recruited patients were deemed to be high risk for parastomal herniation and r and omisation in a controlled trial was contraindicated . Incidence of parastomal related symptoms and recurrences were documented at clinic visits and radiological confirmation of recurrences , when available , was used for final analysis . A control group of patients who underwent stoma resiting without mesh reinforcement for parastomal herniation was used for comparative purpose s. Results 22 patients ( 16 F:6 M , mean age 49 ± 16 years , BMI 33.0 ± 7.0 ) underwent SMART ( 18 open , 4 laparoscopic ) . There were no intra-operative or early stoma complications . During a median FU of 21 months ( range 12–24 ) , four patients ( 19 % ) were diagnosed with recurrent parastomal herniation , one of which required re-operation . The parastomal herniation rate ( 73 % ) in the control group ( 6 F:5 M ) was significantly higher ( p = 0.003 ) although patients had similar age ( 59 ± 15 years , p = 0.1 ) and body-mass index ( 29.0 ± 3.0 , p = 0.1 ) . ConclusionS MART is a new and simple technique of precisely creating a reinforced stoma trephine at both open and laparoscopic surgery . It obviates the technical disadvantages of traditional stoma formation . This pilot study , in a selected group of patients at high risk for parastomal herniation , indicates that the procedure is clinical ly safe but r and omised controlled trials are required to determine its efficacy in reducing parastomal herniation in all patients undergoing elective stoma formation Background Hernias around ostomies are a very common complication , exceeding 50 % . Only a few studies deal with the prophylactic use of mesh to prevent parastomal hernia revealing promising results . Patients and methods Twenty-two patients undergoing elective rectal surgery with a permanent colostomy — one with an ileostomy and two needing surgical correction of a preexisting colostomy — were enrolled in a prospect i ve study . A specially design ed mesh made of polyvinylidene fluoride with a central whole and a funnel arising ( Dynamesh IPST ® ) was prophylactically implanted using an intraperitoneal onlay technique . The patients were followed for a median of 11 ( range 2–19 ) months by clinical examination every 3 months . Results No infection or any other adverse effect was observed , and no parastomal hernia or stoma protrusion could be detected clinical ly . Twelve patients had a routine computed tomography after 6 months , which also excluded any hernia formation . Conclusion The prophylactic use of Dynamesh IPST ® is a safe and effective procedure preventing stoma complications such as hernia formation or prolapse , at least in the short run Abstract Objective . There are no data on the frequency of parastomal hernia ( PSH ) after ileal conduit with a prophylactic mesh . The primary objective of this study was to determine the prevalence of PSH . Secondary objectives were to elaborate whether age , gender , body mass index ( BMI ) , previous laparotomy or diabetes influenced the outcome ; and to find any mesh-related complications . Material s and methods . In a single centre during 2003 - 2012 , a large-pore , lightweight mesh was placed in a sublay position in 114 consecutive patients with ileal conduits . Preoperative and postoperative patient data were retrospectively collected and cross-sectional follow-up was conducted . During the predefined clinical examination a PSH was defined as any protrusion in the vicinity of the ostomy with the patient straining in both an erect and a supine position . Results .Fifty-eight patients ( 24 women and 34 men , mean age 69 years ) had follow-up examinations after a mean of 35 months ( median 32 months ) . Bladder cancer was the most common cause for surgery . Eight patients ( 14 % ) had a PSH . Age , gender , BMI , previous laparotomy and diabetes did not affect the outcome . No mesh-related complications occurred among the 114 patients with a prophylactic mesh . Conclusions . The prevalence of PSH after ileal conduit with a prophylactic mesh corresponded to that of colostomies with a prophylactic mesh . A prophylactic mesh did not seem to be associated with complications . The degree to which a prophylactic mesh may reduce the rate of PSH after an ileal conduit should be established in r and omized trials Introduction Parastomal hernias occur frequently after placement of a permanent colostomy . Preliminary reports have shown a beneficial effect of placing a mesh at the primary operation to prevent the formation of a parastomal hernia . We studied the safety and prophylactic effect of placing a newly design ed polypropylene mesh in an onlay position at the primary operation . Methods This was a prospect i ve study that included 25 patients scheduled for elective colorectal surgery . Risk factors for development of parastomal hernia were recorded before surgery . A prepared lasercut polypropylene mesh with six “ arms ” was placed in an onlay position . Immediate and long-term complications were evaluated by an experienced stoma nurse and a surgeon . Abdominal ultrasound was performed at 6 and 12 months follow-up . Parastomal hernia was defined as both clinical and ultrasonographic signs of protrusion in the vicinity of the stoma . Results The median follow-up time was 12 ( range , 2–26 ) months . One patient died eight days after surgery . Of the 24 patients included , none had infections or immediate complications after surgery . Two patients had minor complications necessitating a local revision of one of the mesh arms . No other long-term complication was found . Two patients had signs of parastomal hernia at 6 and 12 months follow-up , respectively . Conclusions Placement of a polypropylene mesh in an onlay position at the primary operation is a safe procedure and probably results in a low risk of parastomal hernia occurrence Parastomal hernia ( PSH ) is the most common complication of an end‐colostomy and about one‐quarter of patients need operative repair , which is often unsuccessful . A r and omized trial was carried out to compare the results of using mesh or no mesh at the time of formation of a colostomy with the clinical identification of PSH as the primary outcome Background : The prevalence of terminal parastomal hernia ( PH ) after colostomy placement may be as high as 50 % . The effect of the PH may range from discomfort to life-threatening complications . Surgical procedures for repairing PH are difficult to perform and present a high-failure rate . Objective : To reduce the incidence of PH by implanting a lightweight mesh in the sublay position . Material and Methods : R and omized , controlled , prospect i ve study . Patients were scheduled for permanent end colostomy surgery to treat cancer of the lower third of the rectum , performed by the same colorectal surgery team . An Ultrapro lightweight mesh was inserted in the sublay position in the study group . Using simple r and omization , the sample size required was estimated to be 27 per group . Patients were followed-up clinical ly and radiologically with abdominal computed tomography by an independent clinician and a radiologist who were all blind to the aims of the study , 1 month and every 6 months after surgery . Results : The groups were homogeneous in terms of their clinical and demographic characteristics . Surgical time and postoperative morbidity were similar in the 2 groups . Mortality was 0 . No mesh intolerance was reported . In the clinical follow-up ( median : 29 months , range : 13–49 ) , 11/27 ( 40.7 % ) hernias were recorded in the control group compared with 4/27 ( 14.8 % ) in the study group ( P = 0.03 ) . Abdominal computed tomography identified 14/27 ( 44.4 % ) hernias in the control group compared with 6/27 ( 22.2 % ) in the study group ( P = 0.08 ) . Conclusions : Parastomal placement of a mesh reduces the appearance of PH . The technique is safe , well-tolerated , and does not increase morbidity rates BACKGROUND : A large proportion of patients with a colostomy or an ileostomy develop parastomal hernias . The placement of a reinforcing material at the stoma site may reduce parastomal hernia incidence . OBJECTIVE : We aim ed to assess the safety and efficacy of Output:

There were no differences in rates of parastomal infection , stomal stenosis or necrosis . Mesh type and position , and study quality did not have an independent effect on this relationship . CONCLUSION Mesh placed prophylactically at the time of stoma creation reduced the rate of parastomal hernia , without an increase in mesh-related complications

MS2_1shot415

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: The present study was carried out to assess the role of and rogen receptor CAG repeat polymorphism and X chromosome inactivation ( XCI ) pattern among Indian PCOS women and controls which has not been hitherto explored and also to test the hypothesis that shorter CAG alleles would be preferentially activated in PCOS . CAG repeat polymorphism and X chromosome methylation patterns were compared between PCOS and non-PCOS women . 250 PCOS women and 299 controls were included for this study . And rogen receptor CAG repeat sizes , XCI percentages , and clinical and biochemical parameters were measured . The mean CAG repeat number is similar between the cases ( 18.74±0.13 ) and controls ( 18.73±0.12 ) . The obese PCOS women were significantly more frequent in the < 18 and > 20 CAG repeat category than the lean PCOS women , yielding a highly significant odds ( p = 0.001 ) . Among the women with non-r and om X-inactivation , alleles with < 19 repeats were more frequently activated among cases than controls ( p = 0.33 ) . CAG repeat polymorphism by itself can not be considered as a useful marker for discriminating PCOS . We observed a trend of preferential activation of the shorter allele among the PCOS cases with non r and om XCI pattern . In the obese PCOS women , this microsatellite variation may account for the hyper and rogenicity to a larger extent than the lean PCOS women Methods of sample size and power calculations are review ed for the most common study design s. The sample size and power equations for these design s are shown to be special cases of two generic formulae for sample size and power calculations . A computer program is available that can be used for studies with dichotomous , continuous , or survival response measures . The alternative hypotheses of interest may be specified either in terms of differing response rates , means , or survival times , or in terms of relative risks or odds ratios . Studies with dichotomous or continuous outcomes may involve either a matched or independent study design . The program can determine the sample size needed to detect a specified alternative hypothesis with the required power , the power with which a specific alternative hypothesis can be detected with a given sample size , or the specific alternative hypotheses that can be detected with a given power and sample size . The program can generate help messages on request that facilitate the use of this software . It writes a log file of all calculated estimates and can produce an output file for plotting power curves . It is written in FORTRAN-77 and is in the public domain Hyper and rogenism is currently thought to be central to the pathogenesis of polycystic ovarian syndrome ( PCOS ) , a common endocrine disorder in premenopausal women characterized by irregular menstruation and anovulatory infertility . Although hyper and rogenism is characteristic , some women with PCOS have normal serum and rogen levels . All and rogens act through the X-linked and rogen receptor ( AR ) , the N-terminal domain of which contains a polyglutamine tract encoded by a highly polymorphic CAG trinucleotide repeat tract . Recently , variations in this CAG microsatellite tract , while remaining within the normal polymorphic range ( 11 - 38 CAGs ) , have been inversely correlated with receptor activity . Thus , short tracts are associated with high intrinsic AR activity and increased severity and earlier age of onset of the and rogen-regulated tumor prostate cancer , whereas longer CAG tracts are associated with low AR activity and oligospermic infertility . To investigate the role of the CAG repeat tract in PCOS , we measured its length in 91 patients with ultrasound diagnosis of polycystic ovaries , irregular menstrual cycles , and anovulatory infertility and compared them to 112 control subjects of proven fertility with regular menses . Fluorescent-labeled DNA fragments containing the CAG repeat tract were amplified from leucocytic DNA , and their lengths were compared with internal size markers on an automated DNA Sequencer . There were no differences in the mean CAG length between patients and controls when both alleles were considered together or separately . Because there is a subset of PCOS patients whose serum and rogens are normal , we compared differences in CAG length between patients whose serum testosterone ( T ) levels were below the normal laboratory mean , to those that were higher . There was a trend for a lower mean CAG biallelic length among anovulatory patients with T less than 1.73 nmol/L compared with those whose T was more than 1.73 nmol/L ( 22.47 + /- 0.36 vs. 23.25 + /- 0.29 ) . This difference in CAG length between patients with low and high T levels ( 20.38 + /- 0.51 vs. 21.98 + /- 0.29 ) was highly significant ( P = 0.004 ) when only the shorter allele of each individual was considered . Ethnic differences were also evident in our data ; Indian subjects had a significantly shorter AR-CAG length compared with Chinese , being 22.08 + /- 0.50 and 23.16 + /- 0.17 , respectively . Our data indicate an association between short CAG repeat length and the subset of anovulatory patients with low serum and rogens , suggesting that the pathogenic mechanism of polycystic ovaries in these patients could be due to the increased intrinsic and rogenic activity associated with short AR alleles CONTEXT Genetically determined heightened and rogen sensitivity may influence the phenotype of polycystic ovary syndrome ( PCOS ) . To date , studies of the and rogen receptor exon 1 polymorphic CAG repeat have produced conflicting results in PCOS . OBJECTIVE We tested the hypothesis that a lower number of CAG repeats is associated with increased odds of PCOS . We also compared X-chromosome inactivation between cases and controls . DESIGN Women with and without PCOS were genotyped for the CAG repeat and assessed for X-chromosome methylation . Association analyses were performed . SETTING Subjects were recruited from the reproductive endocrinology clinic at the University of Alabama at Birmingham ; controls were recruited from the surrounding community . Genotyping took place at Cedars-Sinai Medical Center in Los Angeles . PARTICIPANTS Participants included 330 women with PCOS and 289 controls ( 77 % white , 23 % black ) . MAIN MEASUREMENTS And rogen receptor genotype , X-chromosome methylation , and phenotyping for PCOS were measured . RESULTS A smaller biallelic mean of CAG repeats was associated with increased odds of PCOS . X-chromosome inactivation was not different comparing cases with controls ; however , in the subset with nonr and om inactivation , the chromosome bearing the shorter CAG allele was preferentially active in PCOS women . CONCLUSIONS Association of shorter CAG repeats with PCOS is consistent with in vitro functional studies demonstrating higher activity of and rogen receptors expressed from alleles with fewer CAG repeats , suggesting inherited alteration in and rogen sensitivity may contribute to PCOS . In some women , such heightened sensitivity may also result from preferential expression of and rogen receptors with shorter alleles . Thus , genetic and epigenetic changes may be involved in the pathogenesis of PCOS A quantitative systematic review , or meta- analysis , uses statistical methods to combine the results of multiple studies . Meta-analyses have been done for systematic review s of therapeutic trials , diagnostic test evaluations , and epidemiologic studies . Although the statistical methods involved may at first appear to be mathematically complex , their purpose is simple : They are trying to answer four basic questions . Are the results of the different studies similar ? To the extent that they are similar , what is the best overall estimate ? How precise and robust is this estimate ? Finally , can dissimilarities be explained ? This article provides some guidance in underst and ing the key technical aspects of the quantitative approach to these questions . We have avoided using equations and statistical notations ; interested readers will find implementations of the described methods in the listed references . We focus here on the quantitative synthesis of reports of r and omized , controlled , therapeutic trials because far more meta-analyses on therapeutic studies than on other types of studies have been published . For practical reasons , we present a stepwise description of the tasks that are performed when statistical methods are used to combine data . These tasks are 1 ) deciding whether to combine data and defining what to combine , 2 ) evaluating the statistical heterogeneity of the data , 3 ) estimating a common effect , 4 ) exploring and explaining heterogeneity , 5 ) assessing the potential for bias , and 6 ) presenting the results . Deciding Whether To Combine Data and Defining What To Combine By the time one performs a quantitative synthesis , certain decisions should already have been made about the formulation of the question and the selection of included studies . These topics were discussed in two previous articles in this series [ 1 , 2 ] . Statistical tests can not compensate for lack of common sense , clinical acumen , and biological plausibility in the design of the protocol of a meta- analysis . Thus , a reader of a systematic review should always address these issues before evaluating the statistical methods that have been used and the results that have been generated . Combining poor- quality data , overly biased data , or data that do not make sense can easily produce unreliable results . The data to be combined in a meta- analysis are usually either binary or continuous . Binary data involve a yes/no categorization ( for example , death or survival ) . Continuous data take a range of values ( for example , change in diastolic blood pressure after antihypertensive treatment , measured in mm Hg ) . When one is comparing groups of patients , binary data can be summarized by using several measures of treatment effect that were discussed earlier in this series [ 3 ] . These measures include the risk ratio ; the odds ratio ; the risk difference ; and , when study duration is important , the incidence rate . Another useful clinical measure , the number needed to treat ( NNT ) , is derived from the inverse of the risk difference [ 3 ] . Treatment effect measures , such as the risk ratio and the odds ratio , provide an estimate of the relative efficacy of an intervention , whereas the risk difference describes the intervention 's absolute benefit . The various measures of treatment effect offer complementary information , and all should be examined [ 4 ] . Continuous data can be summarized by the raw mean difference between the treatment and control groups when the treatment effect is measured on the same scale ( for example , diastolic blood pressure in mm Hg ) , by the st and ardized mean difference when different scales are used to measure the same treatment effect ( for example , different pain scales being combined ) , or by the correlation coefficients between two continuous variables [ 5 ] . The st and ardized mean difference , also called the effect size , is obtained by dividing the difference between the mean in the treatment group and the mean in the control group by the SD in the control group . Evaluating the Statistical Heterogeneity of the Data This step is intended to answer the question , Are the results of the different studies similar ( homogeneous ) ? It is important to answer this question before combining any data . To do this , one must calculate the magnitude of the statistical diversity ( heterogeneity ) of the treatment effect that exists among the different sets of data . Statistical diversity can be thought of as attributable to one or both of two causes . First , study results can differ because of r and om sampling error . Even if the true effect is the same in each study , the results of different studies would be expected to vary r and omly around the true common fixed effect . This diversity is called the within- study variance . Second , each study may have been drawn from a different population , depending on the particular patients chosen and the interventions and conditions unique to the study . Therefore , even if each study enrolled a large patient sample , the treatment effect would be expected to differ . These differences , called r and om effects , describe the between- study variation with regard to an overall mean of the effects of all of the studies that could be undertaken . The test most commonly used to assess the statistical significance of between- study heterogeneity is based on the chi-square distribution [ 6 ] . It provides a measure of the sum of the squared differences between the results observed and the results expected in each study , under the assumption that each study estimates the same common treatment effect . A large total deviation indicates that a single common treatment effect is unlikely . Any pooled estimate calculated must account for the between- study heterogeneity . In practice , this test has low sensitivity for detecting heterogeneity , and it has been suggested that a liberal significance level , such as 0.1 , should be used [ 6 ] . Estimating a Common Effect The questions that this step tries to answers are , 1 ) To the extent that data are similar , what is their best common point estimate of a therapeutic effect , and 2 ) how precise is this estimate ? The mathematical process involved in this step generally involves combining ( pooling ) the results of different studies into an overall estimate . Compared with the results of individual studies , pooled results can increase statistical power and lead to more precise estimates of treatment effect . Each study is given a weight according to the precision of its results . The rationale is that studies with narrow CIs should be weighted more heavily than studies with greater uncertainty . The precision is generally expressed by the inverse of the variance of the estimate of each study . The variance has two components : the variance of the individual study and the variance between different studies . When the between- study variance is found to be or assumed to be zero , each study is simply weighted by the inverse of its own variance , which is a function of the study size and the number of events in the study . This approach characterizes a fixed-effects model , as exemplified by the Mantel-Haenszel method [ 7 , 8 ] or the Peto method [ 9 ] for dichotomous data . The Peto method has been particularly popular in the past . It has the advantage of simple calculation ; however , although it is appropriate in most cases , it may introduce large biases if the data are unbalanced [ 10 , 11 ] . On the other h and , r and om-effects models also add the between- study variance to the within- study variance of each individual study when the pooled mean of the r and om effects is calculated . The r and om-effects model most commonly used for dichotomous data is the DerSimonian and Laird estimate of the between- study variance [ 12 ] . Fixed- and r and om-effects models for continuous data have also been described [ 13 ] . Pooled results are generally reported as a point estimate and CI , typically a 95 % CI . Other quantitative techniques for combining Output:

No statistically significant results were identified by different comparison models or different cut-off point definitions . No publication bias was observed in continuous and dichotomous data analysis . In summary , the current systematic review and meta- analysis found that the AR CAG microsatellite repeat polymorphism is unlikely to be a major determining factor in the development of PCOS

MS2_1shot416

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: PURPOSE We investigated the effects of the administration of ubiquinol ( a reduced form of coenzyme Q(10 ) ) on semen parameters and seminal plasma antioxidant capacity in infertile men with idiopathic oligoasthenoteratozoospermia . MATERIAL S AND METHODS A total of 228 men with unexplained infertility were r and omly assigned 1:1 into 2 groups . Group 1 ( 114 ) received 200 mg ubiquinol daily by mouth for 26 weeks and group 2 ( 114 ) received a similar regimen of placebo . After completion of the 26-week treatment phase , all participants were followed for another 12-week off-drug period . Primary outcomes were improvement in sperm density , sperm motility and sperm strict morphology . RESULTS At the end of the 26-week treatment period mean ± SD sperm density in the ubiquinol and placebo groups was 28.7 ± 4.6 × 10(6)/ml and 16.8 ± 4.4 × 10(6)/ml ( p = 0.005 ) , sperm motility was 35.8 % ± 2.7 % and 25.4 % ± 2.1 % ( p = 0.008 ) , and sperm strict morphology was 17.6 % ± 4.4 % and 14.8 % ± 4.1 % ( p = 0.01 ) of normal sperm , respectively . During the treatment period serum follicle-stimulating hormone levels decreased significantly ( p = 0.02 ) and serum inhibin B concentrations increased significantly ( p = 0.01 ) . During the off-drug period semen parameters gradually returned to baseline values but the differences were still significant for sperm density ( p = 0.03 ) and sperm motility ( p = 0.03 ) . The correlation coefficients analysis revealed a positive association between the duration of treatment with ubiquinol and sperm density ( r = 0.74 , p = 0.017 ) , sperm motility ( r = 0.66 , p = 0.024 ) and sperm morphology ( r = 0.57 , p = 0.027 ) . CONCLUSIONS Ubiquinol was significantly effective in men with unexplained oligoasthenoteratozoospermia for improving sperm density , sperm motility and sperm morphology OBJECTIVE To determine the effectiveness of the in vivo administration of vitamin E as treatment for reactive oxygen species-associated male infertility . SETTING University-based center for reproductive medicine . DESIGN Double-blind r and omized placebo cross-over controlled trial . PATIENTS , PARTICIPANTS Thirty healthy men with high levels of reactive oxygen species generation in semen and a normal female partner . INTERVENTIONS Patients were allocated to two groups according to the blinded r and omization . Each patient received either 600 mg/d of vitamin E ( Ephynal , 300 mg tablets ; F. Hoffman-La Roche Ltd. , Basle , Switzerl and ) ( order A ) or identical placebo tablets ( order B ) for 3 months . Then after a 1-month wash-out period the patients were crossed-over to the other treatment . MAIN OUTCOME MEASURES Improvement in the in vitro function of the spermatozoa measured by conventional semen analysis , computerized motility assessment , determination of reactive oxygen species generation , binding to the zona pellucida of the unfertilized human oocyte in a competitive zona binding assay , development of hyperactivated motility ( both spontaneous and in the presence of 20 % of the natural agonist , human follicular fluid ) and pregnancy . RESULTS Rise in the blood serum vitamin E levels after treatment accompanied by improvement in one of the sperm function tests : the zona binding assay . The zona binding ratio for order A improved from 0.2 ( range 0 to 0.5 ) before treatment to 0.5 ( range 0.1 to 1.0 ) after treatment , the corresponding values for order B were 0.2 ( range 0 to 1.0 ) before treatment and 0.3 ( range 0.1 to 0.7 ) after treatment . CONCLUSION Oral administration of vitamin E significantly improves the in vitro function of human spermatozoa as assessed by the zona binding test OBJECTIVE To determine the effect of ascorbic acid supplementation on the sperm quality of heavy smokers . DESIGN Microscopic examination of semen for 1 month during supplementation with placebo or ascorbic acid at dose levels of 200 or 1,000 mg/d . SETTING Department of Obstetrics and Gynecology , The University of Texas Medical Branch . PARTICIPANTS Seventy-five men ( 20 to 35 years old ) r and omly divided into one of three supplementation groups : placebo , 200 mg and 1,000 mg of ascorbic acid . MAIN OUTCOME Improvement in sperm quality as compared with presupplementation levels and between the three treatment groups . RESULTS The placebo group showed no improvement in sperm quality . The groups receiving ascorbic acid showed improvement in sperm quality with most improvement in the 1,000-mg group . Pearson 's correlation showed statistically significant relationships between the weekly group means of serum and seminal plasma ascorbic acid levels and sperm qualities . CONCLUSIONS Ascorbic acid supplementation of heavy smokers in excess of 200 mg/d results in improved sperm quality We recently introduced reduced glutathione into the therapeutic protocol s in some selected cases of dyspermia . This therapy improved semen quality both in a pilot follow-up study and in a double-blind cross-over trial . This improvement was seen in patients with varicocele and germ-free genital tract inflammation , two pathologies in which production of reactive oxygen species or other toxic compounds could have a pathogenic role . Polyunsaturated fatty acids of phospholipids play a major role in membrane constitution and function and are one of the main targets of the lipoperoxidative process . Therefore , to underst and the therapeutic action of reduced glutathione , we selected infertile patients and studied the modifications produced by the therapy in seminal parameters , biochemical sperm membrane parameters , and the pattern of fatty acids of phospholipids from blood serum and red blood cell membranes ( a model widely accepted as representative of general cell membrane status ) . The results showed an improvement in both sperm parameters and cell membrane characteristics . This study suggests that biochemical modifications in membrane constitution could explain the seminal results of glutathione therapy . On the other h and , it seems likely that only subjects with systemic membrane disturbances associated with and rological pathologies express this membrane damage in spermatozoa , result ing in dyspermia . This sperm alteration can be partially reversed by glutathione therapy if the structural cell membrane damage is not too severe AIM OF THE STUDY To evaluate with an open-label study the efficacy and safety of a complex of nutritional supplements with antioxidant activity ( L-carnitine , acetyl-L-carnitine , fructose , citric acid , selenium , coenzyme Q10 , zinc , ascorbic acid , cyanocobalamin , folic acid ) in primary infertile patients with idiopathic astenoteratozoospermia . METHODS The study was conducted in a population of 114 infertile men ( 96 completed the study ) diagnosed with idiopathic astenoteratozoospermia since at least 18 months . Patients orally received a formulation ( Proxeed - Sigma-Tau ) containing L-carnitine 145 mg , acetyl-L-carnitine 64 mg , fructose 250 mg , citric acid 50 mg , selenium 50 mcg , coenzyme Q10 20 mg , zinc 10 mg , ascorbic acid 90 mg , cyanocobalamin 1.5 mcg , folic acid 200 mcg in combination once a day for 4 months . RESULTS At the end of study , the mean sperm progressive motility showed a statistically significant increase from 18.3 + /- 3.8 to 42.1 + /- 5.5 . Sixteen patients achieved pregnancy during the study . No significant improvement were observed for sperm density and rate of morphologically normal forms . The treatment was well tolerated . CONCLUSIONS Carnitines in association with others functional substances can improve the most important parameters of sperm quality Purpose Surgical repair of varicocele has long been a procedure to correct spermatogenesis . However , the outcome has been reported to be inadequate . We combined varicocelectomy with supplement therapy to evaluate the concurrent effect of these procedures . Methods A prospect i ve r and omized controlled study was undertaken to investigate the effects of zinc sulfate , folic acid and zinc sulfate/folic acid on sperm quality , protamine content and acrosomal integrity following surgical repair of varicocele . Male subjects with palpable varicocele were included in the study and r and omized into four groups . Subjects received Zinc sulfate , Follic acid , Zinc sulfate/Follic acid or placebo for 6 months . A semen sample was obtained before surgery and 3 and 6 months after surgical repair . Semen sample s were evaluated for sperm parameters as well as chromatin content and acrosomal integrity . Results Most of the evaluated parameters showed a mild improvement after varicocelectomy in the placebo group . Interestingly , co-administration of Zinc sulfate and folic acid improved most factors significantly . Folic acid administration but not zinc sulfate could increase sperm number . Hence , Zinc sulfate was better than folic acid when change in morphology was assessed , and none of them was significantly effective in sperm motility . In Zinc sulfate and Follic acid groups , protamine content and halo formation rate significantly improved . Conclusions We may conclude that co-administration of zinc and folic acid significantly improved sperm parameters and increased varicocelectomy outcomes . So , medical treatment with compatible drugs after surgery might be advantageous for obtaining acceptable results The objective of this study was to detect a therapy for idiopathic and varicocele-associated oligoasthenospermia ( OAT ) . Idiopathic and varicocele OAT patients were r and omized into 3 groups . Each group was composed of varying degrees of left varicoceles ( grade d into 5 grade s with echo-color Doppler ) and of idiopathic OATs . Group 1 used a placebo , group 2 used oral L-carnitine ( 2 g/d ) + acetyl-L-carnitine ( 1 g/d ) , group 3 used L-carnitine/acetyl-L-carnitine + 1 x 30-mg cinnoxicam suppository every 4 days . Drugs were administered for 6 months . The groups were composed as follows : group 1 , 71 varicoceles and 47 idiopathic OATs ; group 2 , 62 varicoceles and 39 idiopathic OATs ; group 3 , 62 varicoceles and 44 idiopathic OATs . Sperm concentration , motility , and morphology before during and after treatments were assessed . Pregnancy rates and side effects were recorded . Group 1 did not have modified sperm patterns during treatment . Group 2 had significantly increased sperm patterns at 3 and 6 months into therapy in idiopathic patients and in patients with grade s I , II , and III varicocele , but not in grade s IV and V. Group 3 had significantly increased sperm parameters in all patients , with the exception of grade V varicocele . Group 3 sperm patterns proved significantly higher during therapy than group 2 . All sperm patterns fell to baseline after therapy suspension . Minor side effects occurred . Pregnancy rates were 1.7 % ( group 1 ) , 21.8 % ( group 2 ) , and 38.0 % ( group 3 ) ( P < .01 ) . L-carnitine/acetyl-L-carnitine + cinnoxicam suppositories proved a reliable treatment for low- grade varicoceles and idiopathic OATs Sperm DNA fragmentation is known to compromise male fertility . Previous findings have suggested the implication of oxidative stress in the etiology of this pathological condition . The present study was conducted to find out if the pathologically increased incidence of DNA fragmentation in ejaculated spermatozoa can be reduced by oral treatment with two antioxidants , vitamins C and E. Sixty-four men with unexplained infertility and an elevated ( > or = 15 % ) percentage of DNA-fragmented spermatozoa in the ejaculate were r and omized between an antioxidant treatment ( 1 g vitamin C and 1 g vitamin E daily for 2 months ) group and a placebo group . Sperm DNA fragmentation was evaluated by terminal deoxyribonucleotidyl transferase-mediated dUTP nick-end labeling assay before and after treatment . No differences in basic sperm parameters were found between the antioxidant treatment and the placebo group before or after treatment . However , the percentage of DNA-fragmented spermatozoa was markedly reduced ( P < .001 ) in the antioxidant treatment group after the treatment ( 9.1 + /- 7.2 ) as compared with the pretreatment values ( 22.1 + /- 7.7 ) . No difference in the pretreatment and posttreatment incidence of sperm DNA fragmentation was observed in the placebo group . These data show that sperm DNA damage can be efficiently treated with oral antioxidants administered during a relatively short time period Peroxidative damage induced by reactive oxygen species ( ROS ) has been proposed as one of the major causes of defective Output:

Although there is a wide variability in selected population , dose regimen and final outcomes , nutritional supplements both alone and in combination seems to be able to improve semen parameters ( sperm count , sperm motility and morphology ) and pregnancy rate in infertile men . CONCLUSIONS There are rising evidence s from published r and omized trials and systematic review suggesting that nutritional supplementation may improve semen parameters and the likelihood of pregnancy in men affected by OAT . This improvement , however , is not consistent and there is a wide variation in the treatment regimens used .

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***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Insect hypersensitivity is currently treated by immunization using whole-body extracts . We compared this regimen with immunotherapy using insect venoms or placebo in groups of 20 patients matched for history and sensitivity , as judged by venom skin test , histamine release and IgE antibody to venom . After six to 10 weeks of immunization , systemic reactions to stings occurred in seven of 12 , seven of 11 , and one of 18 patients treated with placebo , whole-body extract , and venom , respectively . Placebo and whole-body extract gave similar results and were significantly less effective than venom immunotherapy ( P less than 0.01 ) . The 14 patients with failure of treatment with whole-body extract and placebo were subsequently provided with venom immunotherapy ; one reacted to a subsequent sting . We conclude that venom immunotherapy is clinical ly superior to therapy on whole-body extract or placebo 24 patients with honey bee sting allergy were treated with either honey bee venom ( HBV ) or monomethoxy polyethylene glycol-coupled HBV ( PEG-HBV ) in a double blind trial . Both treatments induced a strong increase in HBV-specific IgG antibodies in most patients . Immunotherapy with PEG-HBV was much better tolerated than that with HBV . Conversely , patients on HBV did considerably better during a sting challenge with a living honey bee . Only 4 developed a large local and one a mild systemic reaction compared to 7 large local and 3 moderate to severe systemic reactions in the PEG-HBV-group . A higher maintenance dose of PEG-HBV may still be well tolerated but prove more effective at reexposure Venom immunotherapy ( IT ) is a very effective method for the treatment of Hymenoptera venom allergy . We compared safety , efficacy , and modulation of specific immunologic parameters in 70 patients sensitized to Apis mellifera , treated for > or = 5 years with st and ardized quality ( SQ ) aqueous IT , either with a rush ( n = 20 ) or with a cluster ( n = 20 ) induction protocol , or with an SQ depot extract and a cluster induction protocol ( n = 30 ) . We made an open , noncontrolled study . Side effects were monitored and the effects of field stings during the maintenance phase of the treatment and after its interruption were recorded . Skin reactivity to Apis was measured by end point dilution and specific serum immunoglobulin E ( IgE ) were measured by a solid-phase-based assay . The depot IT was better tolerated than aqueous IT with rush induction . This was caused by mainly the lower frequency in the induction phase of systemic side effects ( 3.4 % versus 36.8 % [ p < 0.0041 ] on a " per patient " and 0.1 % versus 0.9 % [ p = 0.0092 ] on a " per dose " basis , respectively ) . The cluster protocol with the aqueous extract tended to be better tolerated that the rush protocol . About one-half of patients from each group were re-stung during the study and all suffered only minor discomfort . Reduction of skin reactivity and of serum-specific IgE was significant in the three groups ( p < 0.02 in all cases ) . SQ Depot IT to Apis venom allergy administered with a cluster protocol induces less side effects and is equally effective then IT with SQ aqueous extract administered with a rush protocol The incidence , time course and nature of systemic reactions to injections of bee and wasp venom during immunotherapy have been estimated in an open , prospect i ve , single centre study . One hundred and nine survivors of moderate to severe systemic reactions to stings from hymenoptera , received courses of bee or wasp venom by monthly subcutaneous injection for up to 3 years . Systemic reactions were recorded after 7.5 % of 946 weekly venom injections during the initial phase of treatment , and after 2.1 % of 1789 monthly maintenance injections . In both phases of treatment , reactions were more frequent after bee ( 17 % of initial phase , 7.8 % of maintenance treatment ) than after wasp ( 3 % of initial phase , 0.3 % of maintenance treatment ) venom injections . The percentage of patients experiencing at least one reaction was also higher for bee ( 46 % ) than for wasp ( 14 % ) sensitive patients . Over 80 % of reactions began within 30 min of injection , over 90 % within 1 h and only two ( 2 % ) , between 1 and 2 h , the remaining six ( 5.5 % ) starting more than 2 h after injection . Only 0.47 % of venom injections produced a systemic reaction which was severe enough to require adrenaline treatment . The female patients experienced more reactions ( 21 % of the wasp , 60 % of the bee , sensitive ) than the males ( 5.5 % wasp , 20 % bee ) . Age and atopy did not appear to be significant risk factors for systemic reactions . We conclude that wasp and bee venom immunotherapy in a conventional dosage regimen was generally well tolerated . No safety advantage was apparent in keeping the patients under observation for more than 1 h after injections . Reactions are more likely to occur during the initial phase of treatment , in women and after bee , rather than wasp , venom injections Background : The safety profile of venom immunotherapy is a relevant issue . We evaluated the frequency of severe adverse events ( SAE ) , associated risk factors , retrospective comparison of pretreatment protocol s including solely H1 receptor blockers and a combination of H1 and H2 receptor blockers during rush Hymenoptera venom immunotherapy . Methods : The study group comprised 118 patients . The treatment was initiated according to a 5-day rush protocol with the use of st and ardized venom allergens of either wasp or honeybee . Results : During the rush induction , side effects occurred in 18 patients ( 15.2 % ) , whereas SAE were present in 7 patients ( 5.9 % ) . Twelve out of 18 ( 66.6 % ) developed anaphylactic reactions on the fourth day of the rush protocol , with the majority of cases at a dose of 40 or 60 µg of the venom extract ( p = 0.001 ) . The frequency of SAE was also significantly higher on the fourth day than thereafter ( p = 0.0001 ) as well as in patients allergic to bee venom ( p = 0.049 ) . All systemic side effects were more frequent in women ( p = 0.0065 ) . However , this relation was not true when SAE were consider ( p = 0.11 ) . A higher percentage of SAE was observed in the subjects pretreated with both H1 and H2 receptor antagonists than in those pretreated with H1 blocker only ( 8.8 vs. 4.1 % ) ; however , the difference was not significant . Conclusions : Considerable severity of allergic adverse events requires particular attention to patients allergic to bee venom and during rush phase , especially when rapidly increasing doses are administered . Pretreatment with H2 blockers is debatable and warrants further investigation This prospect i ve study over 3 years investigated the safety , immunogenicity , and effectiveness of immunotherapy ( IT ) with aluminum hydroxide adsorbed insect venom extracts ( Alutard SQ , ALK Laboratories ) m patients with previous , severe , systemic , IgE‐mediated , anaphylactic reactions to Hymenoptera stings . Seventeen patients were treated with honeybee venom ( BV ) , 13 with yellow‐jacket venom ( YJV ) , and 5 with both . No severe reactions to IT were noted . Only 3 BV‐allergic patients experienced mild systemic reactions of grade s I or II ( 1 per 139 injections ) during the increase phase BACKGROUND Venom immunotherapy rapidly reduces the risk of a systemic sting reaction in adults from 30 % to 70 % to less than 2 % . When venom immunotherapy is stopped after 5 years or longer , the risk of a systemic sting reaction is 5 % to 15 % during the first few years after stopping treatment . It is uncertain whether systemic sting reactions will occur more than 5 years after discontinuing venom immunotherapy and whether treatment can be safely stopped in some patients after less than 5 years . OBJECTIVE The purpose of this study is to estimate the risk of systemic reaction to a sting 10 years after discontinuing treatment and the relative risk after 3 years of treatment compared with that after 5 years or more of treatment . METHODS Among all patients who had venom immunotherapy at our center , we identified 395 patients who stopped treatment : some had dropped out of therapy early ( 6 - 24 months ) , some stopped after 3 to 4 years , and most completed 5 years or more of venom immunotherapy and were advised to stop by the allergist ( many as part of our reported studies of discontinuing venom immunotherapy ) . RESULTS Contact was made with 194 patients , including telephone interviews for sting history and requests to visit the office for skin testing and blood sampling . Of these patients , 74 had been included in our original study of patients who had 5 years or more of venom immunotherapy and had sting challenges after 1 to 5 years off venom immunotherapy , as previously reported . Of the 74 in that original study , 61 were reached for this survey , and 30 reported recent stings , with 5 systemic sting reactions . Another 133 patients who had stopped venom immunotherapy were reached : 82 had 5 or more years of venom immunotherapy , 20 had 3 to 4 years of venom immunotherapy , and 31 had less than 2 years of venom immunotherapy . Of 51 patients stung from this group , 27 had 5 or more years of venom immunotherapy ( no systemic sting reactions ) , and 24 had less than 5 years of venom immunotherapy ( 3 systemic sting reactions ) . We have now observed a total of 113 patients who had 5 or more years of venom immunotherapy and were stung after stopping . Sixteen ( 14 % ) had systemic sting reactions ; most were mild , but 4 were severe . Systemic sting reactions occurred in 12 ( 10.7 % ) of 112 patients stung in the first 4 years off venom immunotherapy and 5 ( 10 % ) of 50 stung more than 5 years off venom immunotherapy . In 4 of 8 patients with current systemic sting reactions , the skin test response was negative , although the venom-IgE response was positive at the previous encounter . All systemic sting reactions were similar in pattern and severity to prevenom immunotherapy reactions in the same patient . CONCLUSIONS We conclude that the risk of systemic sting reactions when venom immunotherapy is stopped after 5 years or longer remains in the reported range of 5 % to 15 % in the 5 to 10 years after stopping venom immunotherapy . This risk of systemic sting reactions does not seem to decrease over time , unlike the progressive decline in immunologic markers ( skin test and venom-IgE responses ) . To prospect ively assess the risk of recurrent systemic sting reactions , there is a need for sting challenge studies of patients who have been off venom immunotherapy for 5 to 10 years and patients who have stopped venom immunotherapy after just 3 to 4 years treatment Venom immunotherapy ( VIT ) with aqueous extracts is considered a life-saving treatment in insect allergy , but systemic side effects are quite common , especially in patients sensitized to Apis mellifera venom . Only a few studies are available regarding depot VIT administered according to the st and ard weekly schedule , while no data are available for cluster VIT with depot preparations . This study was design ed to compare the tolerance of aqueous cluster or rush VIT versus cluster depot VIT in patients sensitized to Apis mellifera . Fifty-five patients with a history of systemic reaction ( grade II to IV according to Müller ) after an Apis mellifera sting were divided at r and om into 3 groups . Forty patients were treated with aqueous VIT ( 20 according to a cluster schedule and 20 according to a rush schedule ) and 15 with Depot VIT according to a cluster schedule . All local and systemic side effects were recorded . Four patients belonging to the aqueous-cluster , 4 belonging to the aqueous-rush , and 1 belonging to the depot-cluster schedule had large local reactions after VIT ( p < 0.009 ) . Systemic side effects were recorded in 1 , 7 and 0 patients ( p < 0.003 ) respectively . No statistically significant difference was found between the two cluster regimens in the frequency of side effects . Depot VIT administered according to a cluster schedule was well tolerated , and its tolerance is better than aqueous-rush VIT for Apis mellifera BACKGROUND Hymenoptera venom hypersensitivity is an epidemiologically important problem . The only effective treatment in the management of venom-allergic patients with a history of generalized reactions to insect sting is specific immunotherapy . OBJECTIVE To demonstrate safety and effectiveness of a modified ultrarush desensitization protocol in venom-allergic patients . METHODS Fifty-seven patients with Hymenoptera venom allergy underwent a specific 1-day ultrarush desensitization by the subcutaneous route , reaching the cumulative dose of 101.1 microg in 2.5 hours . The maintenance dose ( 100 microg ) was administered after 15 days and thereafter once a month . Patients were followed up for a year . Antihistamines were withheld for 15 days before and during desensitization to not underestimate the incidence of adverse effects . RESULTS All patients Output:

This confirms that during VIT systemic reactions are significantly more frequent with honeybee venom compared with vespid venom , while there are no significant overall differences in systemic reactions between aqueous and depot extracts

MS2_1shot418

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Aim . This study investigates consequences of chronic neck pain on muscle function and the rehabilitating effects of contrasting interventions . Methods . Women with trapezius myalgia ( MYA , n = 42 ) and healthy controls ( CON , n = 20 ) participated in a case-control study . Subsequently MYA were r and omized to 10 weeks of specific strength training ( SST , n = 18 ) , general fitness training ( GFT , n = 16 ) , or a reference group without physical training ( REF , n = 8) . Participants performed tests of 100 consecutive cycles of 2 s isometric maximal voluntary contractions ( MVC ) of shoulder elevation followed by 2 s relaxation at baseline and 10-week follow-up . Results . In the case-control study , peak force , rate of force development , and rate of force relaxation as well as EMG amplitude were lower in MYA than CON throughout all 100 MVC . Muscle fiber capillarization was not significantly different between MYA and CON . In the intervention study , SST improved all force parameters significantly more than the two other groups , to levels comparable to that of CON . This was seen along with muscle fiber hypertrophy and increased capillarization . Conclusion . Women with trapezius myalgia have lower strength capacity during repetitive MVC of the trapezius muscle than healthy controls . High-intensity strength training effectively improves strength capacity during repetitive MVC of the painful trapezius muscle This study aim ed at investigating whether patients with neck – shoulder complaints from different aetiologies ( work-related musculo-skeletal disorders , WMSD ; whiplash associated disorders , WAD ) show comparable muscle activation patterns , characterised by higher activation and lower relaxation levels of the trapezius muscles compared to healthy controls . Twenty healthy controls , 21 WMSD and 20 WAD patients with non-acute neck-shoulder pain were recruited for this cross-sectional study . Surface electromyography ( sEMG ) recordings were performed at the upper trapezius muscles during reference contractions , st and ardised computer tasks ( typing and unilateral stress task ) , and rest measurements . sEMG was continuously recorded during these measurements . Outcome measures were root mean square ( RMS ) to study muscle activity , and relative rest time ( RRT ) to study muscle relaxation . Statistical analysis comprised the bootstrap technique and Kruskall – Wallis tests . Results showed no clear evidence for abnormal muscle activation patterns in WMSD and WAD patients compared to healthy controls . However , a tendency was observed for higher RMS levels during the reference contractions and computer tasks in both patient groups compared to healthy controls , and lower RRT levels at the non-dominant side during stress . Both patient groups also showed larger variability in RMS and RRT values . This variability has more often been reported in literature and may suggest the existence of subgroups of pain patients with corresponding different muscle activation patterns not related to aetiology . Future research may focus on identifying these subgroups of patients with neck-shoulder pain The aim of this investigation was to study female workers active in the labour market for differences between those with trapezius myalgia ( MYA ) and without ( CON ) during repetitive pegboard ( PEG ) and stress ( STR ) tasks regarding ( 1 ) relative muscle load , ( 2 ) trapezius muscle blood flow , ( 3 ) metabolite accumulation , ( 4 ) oxygenation , and ( 5 ) pain development . Among 812 female employees ( age 30–60 years ) at 7 companies with high prevalence of neck/shoulder complaints , clinical examination identified 43 MYA and 19 CON . At rest , during PEG , and STR the trapezius muscle was measured using ( 1 ) EMG and MMG , ( 2 ) microdialysis , and ( 3 ) NIRS . Further , subjective pain ratings were scored ( VAS ) . EMGrms in % MVE ( Maximal Voluntary EMG-activity ) , was significantly higher among MYA than CON during PEG ( 11.74 ± 9.09 vs. 7.42 ± 5.56%MVE ) and STR ( 5.47 ± 5.00 vs. 3.28 ± 1.94%MVE ) . MANOVA showed a group and time effect regarding data from the microdialysis : for MYA versus CON group differences demonstrated lower muscle blood flow and higher lactate and pyruvate concentrations . Potassium and glucose only showed time effects . NIRS showed similar initial decreases in oxygenation with PEG in both groups , but only in CON a significant increase back to baseline during PEG . VAS score at rest was highest among MYA and increased during PEG , but not for CON . The results showed significant differences between CON and MYA regarding muscle metabolism at rest and with PEG and STR . Higher relative muscle load during PEG and STR , insufficient muscle blood flow and oxygenation may account for the higher lactate , pyruvate and pain responses among MYA versus CON Abstract Objectives . The purpose of this prospect i ve laboratory study was to follow newly employed workers in the fish or poultry industry for 6 months and investigate possible changes in sensory manifestations and motor performance during low load , repetitive work simulation . It was investigated whether the changes were an effect of employment duration and of development of neck – shoulder complaints . Methods . Twelve newly employed female filleting employees without any sign of neck – shoulder tenderness/pain at the time of employment of 0 months took part in two laboratory recording sessions planned within 1 month of employment and after 6 months of employment at the plant . After 6 months , six workers out of 12 had developed pain and /or tenderness in the neck – shoulder region . The recording sessions evaluated sensory-motor aspects by measuring pressure pain threshold , work-task timing , cutting forces , surface electromyographic activity of four shoulder muscles , displacement of the centre of pressure , and 3D movements of the arm and trunk during simulation of low load , repetitive filleting . Results . Effects due to the duration of employment were observed in both groups , i.e. decreased sensibility to pressure , decrease in the duration of the work cycle , increased arm starting position with respect to the upright position , and decreased range of motion of the arm and trunk ( P<0.05 ) after 6 months . Among the workers with neck – shoulder complaints , increased sensibility to pressure , lower force level , higher electromyographic activity , decreased amplitude of arm movement , and increased trunk posture and movement amplitude ( P<0.05 ) were observed , compared with workers without complaints . Conclusions . Differences in terms of sensory manifestations and motor control strategy were seen after 6 months of employment with or without neck – shoulder complaints . In general , changes in sensory manifestations and motor control strategy after 6 months work were most likely of importance , as they underlined a learning process as employment duration increased . Moreover , the present sensory – motor changes observed among workers with neck – shoulder complaints highlighted the potential physical risk factors associated with low load , repetitive work Abstract Little is known about the mechanisms leading to chronic neck-shoulder musculoskeletal disorders ( MSD ) . The aim of the present study was to investigate and compare motor function during controlled , low load , repetitive work together with chronic or acute experimental neck-shoulder pain . The clinical study was performed on workers with ( n = 12 ) and without ( n = 6 ) chronic neck-shoulder pain . In the experimental study , experimental muscle pain was induced in healthy subjects by intra-muscular injection of hypertonic saline into the trapezius muscle ( n = 10 ) . The assessed parameters related to motor performance were : work task event duration , cutting forces , surface electromyogram ( EMG ) activity in four shoulder muscles , displacement of the centre of pressure , and arm and trunk 3D movements . For controlled cutting force levels , chronic and acute experimental pain provoked a series of changes : a decreased working rhythm and a protective reorganisation of muscle synergy ( experimental study ) , higher EMG frequency contents which may indicate altered motor unit recruitment , and greater postural activity and a tendency towards increased arm and trunk movements . These pain-related changes can play a role in the development of MSD . The present clinical and experimental study demonstrated similar interactions between motor co-ordination and neck-shoulder pain in occupational setting s. We therefore suggest that this experimental model can be used to study mechanisms related to MSD . Information on such modulatory processes may help in the design of new strategies aim ed at reducing the development of MSD The aim of the present study was to investigate reactions in trapezius muscle blood flow ( MBF ) , muscle activity , heart rate variability ( HRV ) and systemic blood pressure ( BP ) to autonomic tests in subjects with chronic neck – shoulder pain and healthy controls . Changes in muscle activity and blood flow due to stress and unfavourable muscle loads are known underlying factors of work-related muscle pain . Aberration of the autonomic nervous system ( ANS ) is considered a possible mechanism . In the present study , participants ( n = 23 Pain , n = 22 Control ) performed autonomic tests which included a resting condition , static h and grip test ( HGT ) at 30 % of maximal voluntary contraction , a cold pressor test ( CPT ) and a deep breathing test ( DBT ) . HRV was analysed in time and frequency domains . MBF and muscle activity were recorded from the upper trapezius muscles using photoplethysmography and electromyography ( EMG ) . The pain group showed reduced low frequency-HRV ( LF ) and SDNN during rest , as well as a blunted BP response and increased LF-HRV during HGT ( ∆systolic 22 mm Hg ; ∆LF(nu ) 27 % ) compared with controls ( ∆systolic 27 ; ∆LF(nu ) 6 % ) . Locally , the pain group had attenuated trapezius MBF in response to HGT ( Pain 122 % Control 140 % ) with elevated trapezius EMG following HGT and during CPT . In conclusion , only HGT showed differences between groups in systemic BP and HRV and alterations in local trapezius MBF and EMG in the pain group . Findings support the hypothesis of ANS involvement at systemic and local levels in chronic neck – shoulder pain The present study investigated the effect of chronic neck muscle pain ( defined as trapezius myalgia ) on neck/shoulder muscle function during concentric , eccentric and static contraction . Forty-two female office workers with trapezius myalgia ( MYA ) and 20 healthy matched controls ( CON ) participated . Isokinetic ( -60 , 60 and 180 degrees s(-1 ) ) and static maximal voluntary shoulder abductions were performed in a Biodex dynamometer , and electromyography ( EMG ) obtained in the trapezius and deltoideus muscles . Muscle thickness in the trapezius was measured with ultrasound . Pain and perceived exertion were registered before and after the dynamometer test . The main findings were that shoulder abduction torque ( at -60 and 60 degrees s(-1 ) ) and trapezius EMG amplitude ( at -60 , 0 and 60 degrees s(-1 ) ) were significantly lower in MYA compared with CON ( p<0.001 - 0.05 ) . Deltoideus EMG and trapezius muscle thickness were not significantly different between the groups . While perceived exertion increased in both groups in response to the test ( p<0.0001 ) , pain increased in MYA only ( p<0.0001 ) . In conclusion , having trapezius myalgia was associated with decreased strength capacity and lowered activity of the painful trapezius muscle . The most consistent differences-in terms of both torque and EMG-were found during slow concentric and eccentric contractions . Activity of the synergistic pain free deltoideus muscle was not significantly lower , indicating specific inhibitory feedback of the painful trapezius muscle only . Parallel increase in pain and perceived exertion among MYA were observed in response to the maximal contractions , emphasizing that heavy physical exertion provokes pain increase only in conditions of myalgia Abstract This cross-sectional study aim ed at investigating the influence of occupational exposure to static and highly repetitive work involving the neck and shoulder muscles , myalgia of and tender point in the trapezius muscle on biomechanical output , and electromyogram ( EMG ) variables ( mean frequency MNF , signal amplitude and ability to relax ) during maximal forward flexions of the shoulder muscles . Groups of 25 cleaners suffering from chronic myalgia of the trapezius muscle , 25 cleaners free from myalgia of the trapezius muscle and 21 teachers performed 150 forward flexions using an isokinetic dynamometer . Perception of fatigue was reported and surface EMG was recorded from four muscles during the endurance test . The cleaners were stronger than the teachers . Myalgia was associated with lower levels of endurance and a high degree of perceived fatigue . The ability to relax the trapezius muscle decreased with age and was even lower in cleaners with and without myalgia . Higher MNF of the deltoid muscle but not of the trapezius muscle was found in the group suffering from myalgia compared to the groups free from myalgia . This cross-sectional study indicated that myalgia of the trapezius muscle did not influence the strength but did influence the endurance of the forward flexor muscles of cleaners . The observed decrease in the ability to relax the trapezius muscle in cleaners compared to healthy teachers might be indicative of a future insufficiency in the muscle . Prospect i ve studies are needed to define the significance of the results presented here The aim of this prospect i ve study was to detect a possible development of trapezius myalgia likely to be work-related in initially healthy female packers . Symptoms were recorded on a five-step intensity scale in a daily diary and in an interview at ten-week intervals . All of the subjects were interviewed concerning assumed risk factors during work and leisure time , and a clinical examination was performed . Within their first year of employment , 17 of 30 subjects developed work-related trapezius myalgia of sufficient intensity to be classified as patients . The median time before a clinical ly confirmed patient status was 23 ( range 6 - 51 ) weeks . The symptoms showed a fluctuating pattern , decreasing on the weekends and during some holidays . In conclusion , likely work-related trapezius myalgia of Output:

During rest and activities below shoulder height , no clear differences in mean Upper Trapezius ( = UT ) EMG activity exist between patients with idiopathic neck pain and a healthy control group . During overhead activities , no conclusion for scapular EMG amplitude can be drawn as a large variation of results were reported . Adaptation strategies during overhead tasks are not the same between studies .

MS2_1shot419

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Background The gut microbiota is interlinked with obesity , but direct evidence of effects of its modulation on body fat mass is still scarce . We investigated the possible effects of Bifidobacterium animalisssp . lactis 420 ( B420 ) and the dietary fiber Litesse ® Ultra polydextrose ( LU ) on body fat mass and other obesity-related parameters . Methods 225 healthy volunteers ( healthy , BMI 28–34.9 ) were r and omized into four groups ( 1:1:1:1 ) , using a computer-generated sequence , for 6 months of double-blind , parallel treatment : 1 ) Placebo , microcrystalline cellulose , 12 g/d ; 2 ) LU , 12 g/d ; 3 ) B420 , 1010 CFU/d in microcrystalline cellulose , 12 g/d ; 4 ) LU + B420 , 12 g + 1010 CFU/d . Body composition was monitored with dual-energy X-ray absorptiometry , and the primary outcome was relative change in body fat mass , comparing treatment groups to Placebo . Other outcomes included anthropometric measurements , food intake and blood and fecal biomarkers . The study was registered in Clinical trials.gov ( NCT01978691 ) . Findings There were marked differences in the results of the Intention-To-Treat ( ITT ; n = 209 ) and Per Protocol ( PP ; n = 134 ) study population s. The PP analysis included only those participants who completed the intervention with > 80 % product compliance and no antibiotic use . In addition , three participants were excluded from DXA analyses for PP due to a long delay between the end of intervention and the last DXA measurement . There were no significant differences between groups in body fat mass in the ITT population . However , LU + B420 and B420 seemed to improve weight management in the PP population . For relative change in body fat mass , LU + B420 showed a − 4.5 % ( − 1.4 kg , P = 0.02 , N = 37 ) difference to the Placebo group , whereas LU ( + 0.3 % , P = 1.00 , N = 35 ) and B420 ( − 3.0 % , P = 0.28 , N = 24 ) alone had no effect ( overall ANOVA P = 0.095 , Placebo N = 35 ) . A post-hoc factorial analysis was significant for B420 ( − 4.0 % , P = 0.002 vs. Placebo ) . Changes in fat mass were most pronounced in the abdominal region , and were reflected by similar changes in waist circumference . B420 and LU + B420 also significantly reduced energy intake compared to Placebo . Changes in blood zonulin levels and hsCRP were associated with corresponding changes in trunk fat mass in the LU + B420 group and in the overall population . There were no differences between groups in the incidence of adverse events . Discussion This clinical trial demonstrates that a probiotic product with or without dietary fiber controls body fat mass . B420 and LU + B420 also reduced waist circumference and food intake , whereas LU alone had no effect on the measured outcomes Objective To evaluate the potential clinical , metabolic , and economic advantages of enteral nutrition over total parenteral nutrition . Design Prospect i ve , r and omized clinical trial . Setting Department of surgery in a university hospital . Patients Two hundred and fifty-seven patients with cancer of the stomach ( n = 121 ) , pancreas ( n = 110 ) , or esophagus ( n = 26 ) were r and omized to receive postoperative total parenteral nutrition ( TPN group , n = 131 ) or early enteral nutrition ( EEN group , n = 126 ) . The nutritional goal was 25 kcal/kg/day . The two nutritional formulas were isocaloric and isonitrogenous , and they were continued until oral intake was at least 800 kcal/day . Measurements Morbidity , mortality , length of hospital stay , and treatment costs were evaluated in all patients . In 40 consecutive patients , selected nutritional , immunologic and inflammatory variables were studied . Moreover , intestinal oxygen tension was evaluated by micropolarographic implantable probes . Main Results The nutritional goal was reached in 100/126 ( 79.3 % ) patients in the EEN group and in 128/131 ( 97.7 % ) patients in the TPN group ( p < .001 ) . In the EEN group , hyperglycemia ( serum glucose , > 200 mg/dL ) was observed in 4.7 % of the patients vs. 9.1 % in the TPN group ( p = NS ) . Alteration of serum electrolyte levels was 3.9 % in the EEN group vs. 13.7 % in the TPN group ( p < .01 ) . No significant difference was found in nutritional , immunologic , and inflammatory variables between the two groups . The overall complication rate was similar ( 40.4 % for TPN vs. 35.7 % , for EEN;p = .52 ) . No difference was detected for either infectious or noninfectious complications , length of hospital stay , and mortality . From postoperative day 5 , intestinal oxygen tension recovered faster in the EEN group than in the TPN group ( 43 ± 5 mm Hg vs. 31 ± 4 mm Hg at day 7;p < .001 ) . EEN was four-fold less expensive than TPN ( $ 25 vs. $ 90.60/day , respectively ) . Conclusion EEN represents a rational alternative to TPN in patients who undergo upper gastrointestinal tract surgery for cancer and who clinical ly require postoperative artificial nutrition BACKGROUND The clinical value of synbiotics in patients undergoing esophagectomy remains unclear . This study investigated the effects of synbiotics on intestinal microflora and surgical outcomes in a clinical setting . METHODS We studied 70 patients with esophageal cancer who were scheduled to undergo esophagectomy . They were r and omly allocated to 2 groups : 1 group received synbiotics before and after surgery , and the other did not . Fecal microflora and organic acid concentrations were determined . Postoperative infections , abdominal symptoms , and duration of systemic inflammatory response syndrome ( SIRS ) were recorded . RESULTS Of the patients , 64 completed the trial ( synbiotics , 30 ; control , 34 ) . The counts of beneficial bacteria and harmful bacteria in the group given synbiotics were significantly larger and smaller , respectively , than those in the control group on postoperative day ( POD ) 7 . The concentrations of total organic acid and acetic acid were higher in the synbiotics group than in the control group ( P < .01 ) , and the intestinal pH in the synbiotics group was lower than that in the control ( P < .05 ) on POD 7 . The rate of infections was 10 % in the synbiotics group and 29.4 % in the control group ( P = .0676 ) . The duration of SIRS in the synbiotics group was shorter than in the control group ( P = .0057 ) . The incidence of interruption or reduction of enteral nutrition by abdominal symptoms was 6.7 % in the synbiotics group and 29.4 % in the control group ( P = .0259 ) . CONCLUSION Perioperative administration of synbiotics in patients with esophagectomy is useful because they suppress excessive inflammatory response and relieve uncomfortable abdominal symptoms through the adjustment of the intestinal microfloral environment Apart from the intestinal environment , inulin induces physiological effects , which includes a reduction in glucose and lipid concentrations and modulation of gastrointestinal motility through the release of different peptides . We hypothesized that inulin-enriched pasta may also improve small intestine permeability in relation to zonulin and glucagon-like peptide 2 ( GLP-2 ) levels in healthy young subjects . Twenty healthy , young male volunteers completed a r and omized , double-blind crossover study consisting of a 2-week run-in period and two 5-week study periods ( 11 % inulin-enriched or control pasta ) , with an 8-week washout period in between . The intestinal barrier function was assessed by lactulose-mannitol excretion in urine . Zonulin values and GLP-2 release were evaluated by enzyme-linked immunosorbent assay . In the inulin group , the urinary lactulose recovery was significantly lower than the other 2 groups . There were no significant differences in urinary mannitol levels between groups . Accordingly , the lactulose-mannitol excretion ratio was significantly decreased in the inulin-enriched pasta group compared with the other 2 groups . The inulin-enriched pasta group had significantly lower zonulin serum values and significantly higher GLP-2 basal values when compared with the baseline and control pasta groups . The dietary use of inulin-enriched pasta preserves intestinal mucosal barrier functioning and modulates circulating levels of zonulin and GLP-2 , suggesting that prebiotics could be used in the prevention of gastrointestinal diseases and metabolic disorders BACKGROUND Although the effect of synbiotic therapy using prebiotics and probiotics has been reported in hepatobiliary surgery , there are no reports of the effect on elective living-donor liver transplantation ( LDLT ) . METHODS Fifty adult patients undergoing LDLT between September 2005 and June 2009 were r and omized into a group receiving 2 days of preoperative and 2 weeks of postoperative synbiotic therapy ( Bifidobacterium breve , Lactobacillus casei , and galactooligosaccharides [ the BLO group ] ) and a group without synbiotic therapy ( the control group ) . Postoperative infectious complications were recorded as well as fecal microflora before and after LDLT in each group . RESULTS Only 1 systemic infection occurred in the BLO group ( 4 % ) , whereas the control group showed 6 infectious complications ( 24 % ) , with 3 cases of sepsis and 3 urinary tract infections with Enterococcus spp ( P = .033 vs BLO group ) . No other type of complication showed any difference between the groups . CONCLUSIONS Infectious complications after elective LDLT significantly decreased with the perioperative administration of synbiotic therapy OBJECTIVE Enteral administration of synbiotics has been reported to be beneficial during various types of surgery , but its clinical value in elderly surgical patients remains unclear . The aim of this study was to quantitatively evaluate the changes in gut microbiota and environment induced by perioperative synbiotic therapy , and to investigate whether it is possible to reduce infectious complications in elderly patients undergoing gastroenterological surgery . METHODS Forty-eight patients over the age of 70 y were r and omized into a group receiving 7 d of preoperative and 10 d of postoperative synbiotic therapy ( S group ) and a control group without synbiotic therapy ( C group ) . A fecal sample collected before and after surgery in each group was used for a quantitative evaluation of the microbiota . RESULTS Forty-eight patients completed the trial ( 25 in the S group and 23 in the C group ) . Synbiotic therapy significantly maintained the status of Bifidobacterium and Lactobacillus , whereas the number of Enterobacteriaceae , Staphylococcus , and Pseudomonas was significantly decreased . The total organic acid and short-chain fatty acid concentrations were increased , and the pH was markedly decreased , in the S group compared with the C group . The incidence of postoperative infectious complications was 12 % in the S group and 36 % in the C group , however , the difference did not reach statistical significance ( P = 0.06 ) . A multivariate analysis revealed that only the use of perioperative blood transfusion was an independent risk factor for infectious complications . CONCLUSIONS Synbiotic therapy improved the intestinal microbial environment , and might decrease the incidence of infectious complications in elderly surgical patients This study was design ed to mainly evaluate the anti-infective effects of perioperative probiotic treatment in patients receiving confined colorectal cancer ( CRC ) respective surgery . From November 2011 to September 2012 , a total of 60 patients diagnosed with CRC were r and omly assigned to receive probiotic ( n = 30 ) or placebo ( n = 30 ) treatment . The operative and post-operative clinical results including intestinal cleanliness , days to first - flatus , defecation , fluid diet , solid diet , duration of pyrexia , average heart rate , length of intraperitoneal drainage , length of antibiotic therapy , blood index changes , rate of infectious and non-infectious complications , postoperative hospital stay , and mortality were investigated . The patient demographics were not significantly different ( p > 0.05 ) between the probiotic treated and the placebo groups . The days to first flatus ( 3.63 versus 3.27 , p = 0.0274 ) and the days to first defecation ( 4.53 versus 3.87 , p = 0.0268 ) were significantly improved in the probiotic treated patients . The incidence of diarrhea was significantly lower ( p = 0.0352 ) in probiotics group ( Output:

RESULTS Most of the review ed articles presented satisfactory results related to the prevention of surgical inflammation in patients undergoing resection of CRC when using strains of Lactobacillus genus , predominantly . CONCLUSIONS Probiotics are suggested to prevent surgical inflammation of CRC , at the same time that the combination of particular microorganisms administered is beneficial to the treatment and surgical recovery

MS2_1shot420

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: OBJECTIVES A clinical trial , involving 203 resin-bonded bridges ( RBBs ) was undertaken to investigate the influence of retainer-type and luting material on the survival of these restorations . METHODS For this evaluation , 157 patients were available ( 14 % of the original sample was lost to follow-up or excluded from the study following the stopping criteria ) . Fifty per cent of the patients were question ed concerning the fate of the RBBs and 59 % of question ed patients were examined clinical ly . The patients that were seen for examination were representatives of the experimental groups . The findings from the clinical examination were compared with the data obtained from the question naire . Missing data were censored at the date of the last available information . Kaplan-Meier estimates were calculated to assess the survivals at the endpoints and compared using Cox 's proportional hazards procedure . RESULTS A significant difference was found between perforated ( P-type ) and etched ( E-type ) RBBs ( P = 0.05 ) for original bonded restorations but not when rebonded RBBs were taken into account . The results of the survival analysis were : anterior P-type , 49 + /- 7 % after 10.5 years : anterior E-type , 57 + /- 7 % after 10.5 years ; posterior P-type , 18 + /- 11 % after 6.8 years ; posterior E-type , 37 + /- 13 % after 10.2 years . Survivals of RBBs that were rebonded once during the evaluation period were 62 + /- 9 % ( 11.0 years ) for anterior RBBs and 51 + /- 11 % ( 10.2 years ) for posterior RBBs . CONCLUSIONS The factor location ( anterior versus posterior ) was as in previous analyses , highly significant . Differences in survival between cementation material s were not significant OBJECTIVES The aim of the present study was to evaluate the outcome of immediate functional loading of implants in single-tooth replacement using two different installation procedures . MATERIAL AND METHODS One hundred and fifty-one subjects , who required single-tooth rehabilitation in the area of 15 - 25 and 35 - 45 , were enrolled in eight private clinics in Italy . The implant sites were r and omly allocated to one of the following treatment groups . In the control group , in which a st and ard preparation procedure for implant placement and submerged healing of the implant was used , abutment connection and loading of the implants were performed 3 months after installation . In the test group 1 , a st and ard preparation procedure for the implant placement and immediate functional loading of implant was carried out . In the test 2 group , however , a modified implant installation procedure ( osteotome technique ) was used followed by immediate functional loading of the implant . Clinical and radiographic examinations were performed at 3 and 12 months of follow-up at all sites . RESULTS Three implants ( 5.5 % ) from the test 2 group ( osteotome preparation ) and one ( 2 % ) from the test 1 group ( conventional drill preparation ) failed to integrate and were removed one and three months after implant installation . The mean marginal bone loss assessed at 12 months was 0.31 mm ( test 1 ) , 0.25 mm ( test 2 ) and 0.38 mm ( control ) ( no statistically significant differences were found between the three treatment groups . ) CONCLUSION It is suggested that immediate functional loading of implants that are placed with a conventional installation technique and with sufficient primary stability may be considered as a valid treatment alternative in a single-tooth replacement Background Various treatment options for the prosthetic treatment of jaws where all molars are lost are under discussion . Besides the placement of implants , two main treatment types can be distinguished : replacement of the missing molars with removable dental prostheses and non-replacement of the molars , i.e. preservation of the shortened dental arch . Evidence is lacking regarding the long-term outcome and the clinical performance of these approaches . High treatment costs and the long time required for the treatment impede respective clinical trials . Methods / design This 14-center r and omized controlled investigator-initiated trial is ongoing . Last patient out will be in 2010 . Patients over 35 years of age with all molars missing in one jaw and with at least both canines and one premolar left on each side were eligible . One group received a treatment with removable dental prostheses for molar replacement ( treatment A ) . The other group received a treatment limited to the replacement of all missing anterior and premolar teeth using fixed bridges ( treatment B ) . A pilot trial with 32 patients was carried out . Two hundred and fifteen patients were enrolled in the main trial where 109 patients were r and omized for treatment A and 106 for treatment B. The primary outcome measure is further tooth loss during the 5-year follow-up . The secondary outcome measures encompassed clinical , technical and subjective variables . The study is funded by the Deutsche Forschungsgemeinschaft ( German Research Foundation , DFG WA 831/2 - 1 , 2 - 2 , 2 - 3 , 2 - 4 , 2 - 5 ) . Discussion The particular value of this trial is the adaptation of common design components to the very specific features of complex dental prosthetic treatments . The pilot trial proved to be indispensable because it led to a number of adjustments in the study protocol that considerably improved the practicability . The expected results are of high clinical relevance and will show the efficacy of two common treatment approaches in terms of oral health . An array of secondary outcome measures will deliver valuable supplementary information . If the results can be implemented in the clinical practice , the daily dental care should strongly profit thereof . Trial registration The trial is registered at Clinical Trials.gov under IS RCT N68590603 ( pilot trial ) and IS RCT N97265367 ( main trial ) PURPOSE This is a 2-year report from an ongoing prospect i ve 5-year multicenter study . The aim of the study was to evaluate the short- and long-term clinical function of CerAdapt ceramic abutments supporting short-span fixed partial dentures ( FPD ) . MATERIAL S AND METHODS Initially , 105 Brånemark System implants were placed in a total of 32 patients at 3 different clinics . After initial healing 103 implants remained . For the support of 36 FPDs , 53 ceramic and 50 titanium abutments were connected , 19 on ceramic and 17 on titanium abutments . RESULTS All patients remained in the study after 2 years . There was a cumulative survival rate of 97.1 % for implants and a cumulative success rate of 97.2 % for FPDs ( 94.7 % for ceramic and 100 % for titanium abutment-supported FPDs ) . One of 53 ceramic but none of 50 titanium abutments failed , giving a cumulative success rate of 98.1 % and 100 % , respectively , for the abutments . Soft tissue around abutments and adjacent teeth appeared healthy . More crown margins were placed submucosally at titanium ( 31 % ) than at ceramic ( 14 % ) abutments , and the level of the periimplant mucosa was relatively stable in relation to the abutment/crown . No differences were seen between ceramic and titanium abutments regarding bleeding of the periimplant mucosa . There was a minimal marginal bone loss recorded after 1 year , which was slightly more at titanium ( 0.4 mm ) than at ceramic ( 0.2 mm ) abutments . All patients and dentists were satisfied with the achieved esthetic result and no FPD was remade because of compromised esthetics . CONCLUSION So far the ceramic abutments have worked very well and the 2-year results have been very encouraging for CerAdapt abutments supporting short-span FPDs . However , ceramic material s tend to undergo static fatigue , and it is therefore important to wait for the 5-year results before making any more definite statement about the long-term prognosis for CerAdapt abutments A r and omized clinical trial was undertaken to compare the effectiveness of two partial denture design s , one with I-bar ( bar ) and the other with circumferential retainers ( circumferential ) , in 134 patients with Kennedy class I and class II edentulous conditions . A total of 30 partial dentures were considered failures , five because of abutment failures and 25 because of the lack of removable partial denture use for eating . The 5-year success rate of 71.3 % for the circumferential design did not differ significantly from the 76.6 % for the bar design ( p > 0.05 ) . There were no discernible changes in the nine periodontal health components of abutment teeth with either of the two design s after 60 months . The results indicate that the two design s do not differ significantly in terms of success rates , maintenance care , and effects on abutment teeth . A well-constructed removable partial denture of either design , supported by favorable abutments and accompanied by a regular recall program offers a satisfactory treatment modality AIM The aim of this research was to evaluate patients ' preferences for resin analogs of four major connector design s formulated to have equal rigidity once fabricated in the same alloy . METHODS AND MATERIAL S Nineteen Kennedy Class I or II partially edentulous patients participated at two centers . The four major connector analogs ( MCAs ) were fabricated for each subject using light-polymerizing acrylic resin . The subjects were asked to wear each of them in the mouth for 30 seconds in six pairs in r and om order , and to report their preference for each pair . Based on these data , the four analogs were ranked in a descending preference order for each patient . Within-subject comparisons preferences were performed with the Friedman test , and the multiple comparisons were performed with the Wilcoxon Signed Ranks test for data of each sample independently . RESULTS Statistically significant and consistent preference orders were revealed for both sample s , and the thin and wide design was significantly preferred to the thick and narrow design . However , a higher variation was observed for the first preference of each subject . CONCLUSIONS Subjects demonstrated a tendency to prefer thinner MCAs . However , the individual predilections of patients may not be an appropriate basis for an attempt to find a ' best design ' applicable to all patients Pulpal injury commonly occurs with tooth preparation for complete fixed partial dentures . This can be documented by the substantial incidence of pain after tooth preparation . In this study , a 4 % potassium nitrate-zinc oxide eugenol temporary cement was used to secure provisional crowns over recently prepared teeth and it significantly reduced the incidence and severity of pain after tooth preparation and impression taking PURPOSE The aim of this study was to evaluate the short-term bone level response around immediately placed and provisionally restored implants using a platform switching concept . MATERIAL S AND METHODS Twenty-two implants with a platform diameter of 5.5 mm were immediately placed in healthy maxillary sites in 22 patients . Result ant circumimplant spaces were filled with a mixture of bovine bone matrix and collagen . The implants were r and omly divided into two equal groups : 11 implants connected with 3.8-mm-diameter abutments ( test group ) and 11 with 5.5-mm-diameter ones ( control ) . Provisional crowns were adapted and adjusted for nonfunctional immediate placement on each implant and the final crowns were constructed 2 months later . Posttreatment assessment s were carried out by an independent trained observer at the time of implant placement ( baseline ) , at definitive prosthesis insertion , and every 6 months thereafter . These assessment s included periapical radiographs , pocket probing depths ( PPD ) , bleeding on probing ( BOP ) , and modified Plaque Index ( mPII ) on both implants and first proximal teeth . An image analysis software application was used to compare the bone crestal heights at the mesial and distal aspects of the implants . RESULTS The mean follow-up observation period was 25 months and all implants were judged to be successfully osseointegrated . In the test group , radiographic analysis showed an average bone reduction level of 0.30 mm ( SD = 0.16 mm ) . This mean value was statistically significantly different ( P < or = .005 ) from the average reduction in the control group ( mean = 1.19 mm , SD = 0.35 mm ) . No differences between the two groups in PPD , BOP , or mPII were found . CONCLUSION This preliminary study suggests that immediate single implant restorations in specific maxillary sites with subsequent platform switching may provide peri-implant alveolar bone-level stability The clinical question at issue , whether it is possible to combine implants and natural teeth via fixed bridges , is of current interest . The treatment of the subjects of this prospect i ve study was performed between June 1984 and December 1986 . This article presents the 5-year results of the study . The consecutive patient material comprised 23 patients with Applegate Kennedy Class I residual dentition in the m and ible and a complete maxillary denture . All 23 patients were provided with implants ad modum Brånemark in each m and ibular quadrant . One side was r and omized to rehabilitation with fixed bridge between the distal tooth of the residual dentition and an implant ; the other side received a free-st and ang bridge on 2 implants . The fixture survival rate was 88 % . No difference was found between the two sides . Bridge stability was 89 % for the implant bridges and 91 % for the combination bridges . The change in marginal bone level at the implants was small during the 5-year follow up period ( on average 0.1 - 0.3 mm ) and with no difference between the two sides . In conclusion , it was not possible to demonstrate any higher risk of implant or prosthetic failure for tooth-implant fixed bridges compared with implant-supported bridges OBJECTIVES The aim was to test whether or not zirconia abutments exhibit the same survival and technical/biological Output:

There was insufficient evidence to determine whether one type of removable dental prosthesis ( RDP ) was better or worse than another . With fixed dental prostheses ( FDPs ) , there was no evidence that high gold alloys are better or worse than other alloys , nor that gold alloys or frameworks are better or worse than titanium . There is insufficient evidence to determine whether zirconia is better or worse that other FDP material s , that ceramic abutments are better or worse than titanium , or that one cement was better or worse than another in retaining FDPs . Based on trials meeting the inclusion criteria for this review , there is insufficient evidence to recommend a particular method of tooth replacement for partially edentulous patients

MS2_1shot421

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: This study employed a self-report question naire in a Solomon four-groups design to assess the efficacy of suicide intervention classes in achieving their instructional objectives . Because adolescents are often the first to know of a peer 's suicidal thoughts or plans , the goal of the classes was to increase the likelihood that students who come into contact with potentially suicidal peers can more readily identify them and will be consistently inclined to take responsible action on their behalf . Students who participated in the classes as compared to controls showed significant gains in relevant knowledge about suicidal peers and significantly more positive attitudes toward help seeking and intervening with troubled peers . Results of this study will be used to strengthen components of the lessons aim ed at enhancing the likelihood of performance of responsible interventions Gatekeeper-training programs , design ed to increase identification and referral of suicidal individuals , are widespread but largely untested . A group-based r and omized trial with 32 schools examined impact of Question , Persuade , Refer ( QPR ) training on a stratified r and om sample of 249 staff with 1-year average follow-up . To test QPR impact , the authors introduced and contrasted 2 models of gatekeeper-training effects in a population : gatekeeper surveillance and gatekeeper communication . Intent-to-treat analyses showed that training increased self-reported knowledge ( effect size [ ES ] = 0.41 ) , appraisal s of efficacy ( ES = 1.22 ) , and service access ( ES = 1.07 ) . Training effects varied dramatically . Appraisal s increased most for staff with lowest baseline appraisal s , and suicide identification behaviors increased most for staff already communicating with students about suicide and distress . Consistent with the communication model , increased knowledge and appraisal s were not sufficient to increase suicide identification behaviors . Also consistent with the communication model were results from 2,059 8th and 10th grade rs surveyed showing that fewer students with prior suicide attempts endorsed talking to adults about distress . Skill training for staff serving as " natural gatekeepers " plus interventions that modify students ' help-seeking behaviors are recommended to supplement universal gatekeeper training Suicide is a major public health problem . Nationally , suicide is the third leading cause of death for adolescents . The purpose of this quality improvement project was to initiate and evaluate a gatekeeper suicide-prevention program within a local school system targeting faculty and staff without a medical or psychology background who interact regularly with middle- and high-school students . Following the implementation of this program , evaluation of increased knowledge related to adolescent suicide prevention was completed . All participants completed a pretest and posttest , and results indicate that the staff members ' knowledge about identification of risk factors , behavioral responses to suicidal students , and knowledge of community re sources were increased . This project highlights the need for planned and sustainable education and training for faculty and school staff who regularly interact with adolescents . Additionally , the importance of continued monitoring , training , and advocating for suicide prevention programming is noted OBJECTIVE To examine symptomatology and mental health service use following students ' contact with a large urban school district 's suicide prevention program . METHOD In 2001 school district staff conducted telephone interviews with 95 r and omly selected parents approximately 5 months following their child 's contact with the district 's suicide prevention program , a School Gatekeeper Training model . Parents provided information regarding service use , their child 's depressive symptoms ( using the Diagnostic Interview Schedule for Children Predictive Scale , Depression module ) , and their perceptions of their child 's need for services . Information about the crisis intervention was abstract ed from a st and ardized assessment form . RESULTS More than two thirds of students received school or community mental health services following contact with the suicide prevention program . Depressive symptoms , but not past year suicide attempt , predicted community mental health service use . Latino students had lower rates of community mental health service use than non-Latinos . School-based service use did not differ by student characteristics including race/ethnicity . CONCLUSIONS Most students identified by a school-based suicide prevention program received follow-up care , although Latinos were less likely to access services outside the school . School-based mental health services may be an important way in which underserved population s at risk of suicide can receive care A national r and om sample of 228 high school health teachers completed a 45-item survey to examine their perceived self-efficacy regarding adolescent suicide . Most respondents were female , White , and held master 's degrees . Most believed it was their role to recognize students at risk for suicide , believed that if they did recognize students at risk it would reduce the chances that the student would commit suicide , and believed that one of the most important things they could do would be to prevent a suicidal student from committing suicide . However , only 9 % believed they could recognize a student at risk for suicide . High efficacy expectations scores were associated with working at a school that offered an inservice program on adolescent suicide , included teaching about suicide prevention in the curriculum , and had a crisis intervention team . This study suggests that teacher health education programs should spend more time on developing the skills necessary to identify students at risk . In addition , a comprehensive school suicide prevention program is strongly encouraged for all high schools Background The traditional wait-listed design , where half are r and omly assigned to receive the intervention early and half are r and omly assigned to receive it later , is often acceptable to communities who would not be comfortable with a notreatment group . As such this traditional wait-listed design provides an excellent opportunity to evaluate short-term impact of an intervention . We introduce a new class of wait-listed design s for conducting r and omized experiments where all subjects receive the intervention , and the timing of the intervention is r and omly assigned . We use the term “ dynamic wait-listed design s ” to describe this new class . Purpose This paper examines a new class of statistical design s where r and om assignment to intervention condition occurs at multiple times in a trial . As an extension of a traditional wait-listed design , this dynamic design allows all subjects to receive the intervention at a r and om time . Motivated by our search for increased statistical power in an ongoing school-based trial that is testing a program of gatekeeper training to identify suicidal youth and refer them to treatment , this new design class is especially useful when the primary outcome is a count or rate of occurrence , such as suicidal behavior , whose rate can fluctuate over time due to uncontrolled factors . Methods Statistical power is computed for various dynamic wait-listed design s under conditions where the underlying rate of occurrence is allowed to vary non systematic ally . We also present as an example a large ongoing trial to evaluate a gatekeeper training suicide prevention program in 32 schools which we initially began as a classic r and omized wait-listed design . The primary outcome of interest in this study is the count of the number of children who are identified by the school system as having suicidal thoughts or behaviors who are then vali date d as being suicidal by mental health professionals in the community . Results A general result shows that dynamic wait-listed design s always have higher statistical power over a traditional wait-listed design . This power increase can be substantial . Efficiency gains of 33 % are easy to obtain for situations where the intervention has a small effect and the variation in rate across time is quite high . When the rate variation for an outcome is very low or the intervention effect is large , efficiency gains approach 100 % . A small increase in the number of times where r and om assignment occurs from 2 – for the st and ard wait-listed design , to say 4 – can provide a large reduction in variance . Efficiency gains can also be high when converting st and ard wait-listed design to a dynamic one half-way into the study . Limitations As with all wait-listed design s , dynamic wait-listed design s can only be used to evaluate short-term impact . Since all subjects eventually receive the intervention , no comparison can be made after the end of the r and om assignment period . The statistical power benefits are primarily limited to outcomes that can be treated as count or time to event data . Conclusions A dynamic design r and omly assigns units – either individuals or groups – to start the intervention at varying times during the course of the study . This design is useful in testing interventions that screen for new or existing cases , as well as testing the scalability of interventions as they are disseminated or exp and ed system wide . They can improve on the traditional wait-listed design both in terms of statistical power and robustness in the presence of exogenous factors . This paper demonstrates that such design s yield smaller st and ard errors and can achieve higher statistical power than that of a st and ard wait-listed design . Just as important , dynamic design s can also help reduce the logistical challenges of implementing an intervention on a wide scale . When the intervention requires that significant training re sources be allocated throughout the study , the dynamic waitlisted design is likely to increase the rate of training and lead to a higher level of program implementation Objectives : To evaluate a suicide prevention training workshop for staff working in the field of traumatic brain injury ( TBI ) and to develop new measures for evaluation of similar training in the future . Design : A prospect i ve controlled pre- and posttest evaluation with a 6-month follow-up . Subjects : Multidisciplinary TBI rehabilitation and disability staff from the state of Victoria attending the workshop ( n = 50 ) and an equivalent control group ( n = 28 ) recruited from New South Wales . Setting : A statewide training workshop was held at a major rehabilitation center in Melbourne . Outcome measures : Three design ed measures including an objective knowledge test , a self- assessment inventory of knowledge/skills and an attitudinal inventory . Results : Participants recorded statistically significant increases in their scores comparing the pre- to postworkshop evaluations . Many of these gains were maintained at the 6-month follow-up evaluation . In contrast , the control group had scores equivalent to those of workshop participants on the pretest evaluations but recorded no similar increase at follow-up . Factor analysis found that the knowledge and skills self- assessment inventory had 2 factors , each having good internal reliability . Conclusion : The current workshop has proved effective in increasing staff knowledge and skills in the assessment and management of people with TBI exhibiting suicidal behaviors . Finally , the initial development of a knowledge and skills self- assessment measure shows promise , providing a re source for the ongoing evaluation of suicide prevention training in the TBI field In this pilot study we report on proximate outcomes of a 1-hour community gatekeeper training in-service for 76 non clinical employees in a university hospital workplace setting . Pre-post analyses result ed in positive changes in participants ' knowledge about suicide and attitudes ( self-efficacy ) about intervening with suicidal individuals . A subset of participants engaged in role play practice of gatekeeper skills following training and rated the experience positively . Fifty-five observations were rated using an observational measure developed for this study and approximately half of these demonstrated satisfactory skills post training . Participants in this workplace gatekeeper training reported sharing new knowledge and skills with family , friends , and coworkers The purpose of this article was to describe patterns of poor mental health/depression ( PMHD ) in a national sample of college students and the relationships among PMHD , alcohol consumption , harm , and abuse . Responses to mailed question naires completed by a r and om sample of 27,409 students at 119 colleges were analyzed using logistic regression . Nationally , 4.8 % of students reported PMHD . The average college prevalence was 5.01 % ( range , 0.68 % to 13.23 % ) . Students with PMHD were more likely than their peers to be female , nonwhite , and from low socioeconomic status families ; less likely to report never drinking ; as likely to report frequent , heavy , and heavy episodic drinking ; and more likely to report drinking to get drunk . Students with PMHD — especially females — were more likely to report drinking-related harms and alcohol abuse . College is a critical context for study ing youth mental health . The interrelationship of mental health problems and their clustering by group and college are important considerations for prevention and treatment BACKGROUND Suicide is a significant public health problem worldwide that requires evidence -based prevention efforts . One approach to prevention is gatekeeper training . Gatekeeper training programs for community members have demonstrated positive changes in knowledge and attitudes about suicide . Changes in gatekeeper skills have not been well established . AIMS To assess and to predict the impact of a brief , gatekeeper training on community members ' observed skills . METHODS Participants in a community gatekeeper training were employees at US universities . 50 participants were r and omly selected for skills assessment and videotaped interacting with a st and ardized actor prior to and following training . Tapes were reliably rated for general and suicide-specific skills . RESULTS Gatekeeper skills increased from pre- to posttest : 10 % of participants met criteria for acceptable gatekeeper skills before training , while 54 % met criteria after training . Pretraining variables did not predict increased skills . LIMITATIONS Results do not provide conclusions about the relationship between observed gatekeeper skills and actual use of those skills in the future . CONCLUSIONS Gatekeeper training enhances suicide-specific skills for the majority of participants . Other strategies , such as behavioral rehearsal , may be necessary to enhance skills in the remaining participants BACKGROUND Gatekeeper suicide prevention programs train staff to increase the identification and referral of suicidal individuals to the appropriate re sources . AIMS We evaluated Act on FACTS : Making Educators Partners in Youth Suicide Prevention ( MEP ) , which is an online training program design ed to enhance the knowledge of suicide risk factors and warning signs as well as improve participants ' attitudes and self-efficacy/confidence . METHOD School personnel ( N = 700 ) completed a survey administered before and immediately after the training to assess gains in training outcomes and to evaluate participants ' satisfaction with the training . RESULTS Results indicated that MEP participants demonstrated significant increases in suicide knowledge , attitudes , and self-efficacy . Moreover , exploratory analyses revealed moderating effects of professional role on pre-/posttest changes in self-efficacy , but not suicide knowledge or attitudes . Specifically , guidance counselors demonstrated significantly smaller increases in self-efficacy/confidence compared with teachers and classroom aids , whereas teachers demonstrated significantly larger increases in self-efficacy/confidence compared with administrators . The majority of school personnel who completed the MEP program were satisfied with the training content and experience . CONCLUSION Although the current findings are promising , more rigorous evaluations employing r and omized controlled research design s are warranted to adequately determine the effectiveness of the MEP program Output:

There is also an urgent need to investigate how best improvements in knowledge and skills can be translated into behavioural change

MS2_1shot422

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND If treatment of the axilla is indicated in patients with breast cancer who have a positive sentinel node , axillary lymph node dissection is the present st and ard . Although axillary lymph node dissection provides excellent regional control , it is associated with harmful side-effects . We aim ed to assess whether axillary radiotherapy provides comparable regional control with fewer side-effects . METHODS Patients with T1 - 2 primary breast cancer and no palpable lymphadenopathy were enrolled in the r and omised , multicentre , open-label , phase 3 non-inferiority EORTC 10981 - 22023 AMAROS trial . Patients were r and omly assigned ( 1:1 ) by a computer-generated allocation schedule to receive either axillary lymph node dissection or axillary radiotherapy in case of a positive sentinel node , stratified by institution . The primary endpoint was non-inferiority of 5-year axillary recurrence , considered to be not more than 4 % for the axillary radiotherapy group compared with an expected 2 % in the axillary lymph node dissection group . Analyses were by intention to treat and per protocol . The AMAROS trial is registered with Clinical Trials.gov , number NCT00014612 . FINDINGS Between Feb 19 , 2001 , and April 29 , 2010 , 4823 patients were enrolled at 34 centres from nine European countries , of whom 4806 were eligible for r and omisation . 2402 patients were r and omly assigned to receive axillary lymph node dissection and 2404 to receive axillary radiotherapy . Of the 1425 patients with a positive sentinel node , 744 had been r and omly assigned to axillary lymph node dissection and 681 to axillary radiotherapy ; these patients constituted the intention-to-treat population . Median follow-up was 6·1 years ( IQR 4·1 - 8·0 ) for the patients with positive sentinel lymph nodes . In the axillary lymph node dissection group , 220 ( 33 % ) of 672 patients who underwent axillary lymph node dissection had additional positive nodes . Axillary recurrence occurred in four of 744 patients in the axillary lymph node dissection group and seven of 681 in the axillary radiotherapy group . 5-year axillary recurrence was 0·43 % ( 95 % CI 0·00 - 0·92 ) after axillary lymph node dissection versus 1·19 % ( 0·31 - 2·08 ) after axillary radiotherapy . The planned non-inferiority test was underpowered because of the low number of events . The one-sided 95 % CI for the underpowered non-inferiority test on the hazard ratio was 0·00 - 5·27 , with a non-inferiority margin of 2 . Lymphoedema in the ipsilateral arm was noted significantly more often after axillary lymph node dissection than after axillary radiotherapy at 1 year , 3 years , and 5 years . INTERPRETATION Axillary lymph node dissection and axillary radiotherapy after a positive sentinel node provide excellent and comparable axillary control for patients with T1 - 2 primary breast cancer and no palpable lymphadenopathy . Axillary radiotherapy results in significantly less morbidity . FUNDING EORTC Charitable Trust PURPOSE To compare the diagnostic accuracy of ultrasonographically (US)-guided fine-needle aspiration biopsy ( FNAB ) and core-needle biopsy ( CNB ) of the axillary lymph nodes ( LNs ) of patients with newly diagnosed invasive breast cancer . MATERIAL S AND METHODS This prospect i ve single-center study had institutional review board approval , and written informed consent was obtained . Between April 2011 and March 2012 , 178 consecutive patients ( 182 axillae ) were evaluated by using axillary US . Sixty-six axillae fulfilled the inclusion criteria ( cortical thickness greater than 2 mm or abnormal morphologic characteristics ) , and patients with these axillae underwent US-guided axillary LN biopsy . Both FNAB and CNB were obtained from the same suspicious LN . Patients with biopsy-proved metastasis underwent axillary clearance , and those with a negative biopsy underwent sentinel LN biopsy with completion axillary clearance if needed . Diagnostic performance was calculated separately for US , FNAB , and CNB . Statistical differences in sensitivities were evaluated by using the McNemar test . RESULTS From the total study population , 45.6 % ( 83 of 182 axillae ) had metastases . A total of 66 axillae underwent both FNAB and CNB . The sensitivity for US was 61.4 % ( 51 of 83 axillae ) , and specificity was 84.8 % ( 84 of 88 axillae ) . The sensitivities for FNAB and CNB were 72.5 % ( 37 of 51 axillae ) and 88.2 % ( 45 of 51 axillae ) , respectively ( P = .008 ) . Specificity for both was 100 % ( 15 of 15 axillae ) . The negative predictive value for FNAB was 81.7 % , and that for CNB was 91.2 % . The positive predictive value was 100 % for both methods . CONCLUSION When accurate preoperative staging of the axilla is needed in patients with newly diagnosed invasive breast cancer , CNB is more sensitive than FNAB CRA506 Background : Sentinel node biopsy ( SNB ) eliminates the need for axillary dissection ( ALND ) in patients whose sentinel node ( SN ) is tumor-free . However , completion ALND remains the gold st and ard for patients with a tumor-involved sentinel node . ALND achieves regional control , but its effect on survival remains controversial . The main objective of ACOSOG Z0011 was to compare outcomes of patients with hematoxylin and eosin ( H&E ) detected metastasis in SN managed with or without ALND and no axillary irradiation . METHODS Clinical ly node-negative patients who underwent SN biopsy and had 1 or 2 SN with metastases detected by H&E were r and omized to ALND or no further axillary specific treatment . All patients were treated with lumpectomy and opposing tangential field irradiation . Adjuvant systemic therapy was at the discretion of their physicians . Overall survival ( OS ) , disease-free survival ( DFS ) , and locoregional control were evaluated . RESULTS 446 patients were r and omized to SNB alone and 445 to SNB plus ALND . Patients treated with SNB alone were similar to those treated with SNB + ALND with respect to age , tumor size , Bloom-Richardson score , estrogen receptor status , adjuvant systemic therapy , tumor type , and T stage . Patients r and omized to SNB alone had a median of two lymph nodes removed whereas patients r and omized to ALND had a median of 17 lymph nodes removed . 17.6 % of ALND patients had 3 or more involved nodes compared to 5.0 % of SNB patients ( p < 0.001 ) . Median follow-up is 6.2 years . 5-year in breast recurrence after ALND was 3.7 % compared to 2.1 % for SNB ( p = 0.16 ) while 5-year nodal recurrence was 0.6 % compared to 1.3 % ( p = 0.44 ) respectively . The five-year OS for patients undergoing SNB + ALND is 91.9 % compared to 92.5 % for SNB alone ( p = 0.24 ) , and DFS is 82.2 % compared to 83.8 % respectively ( p = 0.13 ) . CONCLUSIONS Despite the widely held belief that ALND improves survival , no significant difference was recognized by this study of SN node-positive women . Although the study closed early because of low accrual/event rate , it is the largest phase III study of ALND for node-positive women , and it demonstrates no trend toward clinical benefit of ALND for patients with limited nodal disease . [ Table : see text ] Ultrasound ( US ) is more sensitive than physical examination alone in determining axillary lymph node involvement during preliminary staging of breast carcinoma . Due to occasional overlap of sonographic features of benign and indeterminate lymph nodes , fine‐needle aspiration ( FNA ) of sonographically indeterminate/suspicious lymph nodes can provide a more definitive diagnosis than US alone . This study was undertaken to determine the diagnostic accuracy of US‐guided FNA of indeterminate/suspicious/metastatic‐appearing axillary lymph nodes during the initial staging of breast carcinoma 96 Background : The sensitivity and specificity of FNAB and CNB performed in suspicious axillary LNs have ranged from 56 % to 86 % and from 91 % to 100 % , because FNAB and CNB are operator- and institution-dependent procedures . In addition , previous studies concerning the diagnostic accuracy of these procedures have reported results from only FNAB or CNB . So , the purpose of this study was to determine the diagnostic accuracy of axillary US and compare that of US-guided FNAB with CNB for axillary staging in the same breast cancer population . METHODS Of 220 breast cancer patients who underwent preoperative or prechemotherapy axillary US for axillary staging , 52 patients who underwent US-guided FNAB and CNB of cortical thickening and /or compressed hilum of lymph nodes on US were prospect ively enrolled . US and FNAB/CNB findings were compared with final pathology from sentinel lymph node biopsy or axillary lymph node dissection . RESULTS Forty-eight patients met the final study criteria ; we excluded 4 who had received primary systemic chemotherapy and showed negative FNAB/CNB results with negative final post-operative pathology . Positive predictive value ( PPV ) of axillary US was 54 % . The sensitivity and specificity of FNAB were 73 % and 100 % , and those of CNB were 77 % and 100 % . Results did not significantly differ between US-guided CNB and FNAB . The complication rates of FNAB and CNB were 4 % , and FNAB and CNB cost $ 180 and $ 350 , respectively . CONCLUSIONS Both US-guided CNB and FNAB were useful for axillary staging in breast cancer patients with high sensitivity . However , FNAB is recommended based on the advantages of low cost and minimal invasiveness A quantitative systematic review , or meta- analysis , uses statistical methods to combine the results of multiple studies . Meta-analyses have been done for systematic review s of therapeutic trials , diagnostic test evaluations , and epidemiologic studies . Although the statistical methods involved may at first appear to be mathematically complex , their purpose is simple : They are trying to answer four basic questions . Are the results of the different studies similar ? To the extent that they are similar , what is the best overall estimate ? How precise and robust is this estimate ? Finally , can dissimilarities be explained ? This article provides some guidance in underst and ing the key technical aspects of the quantitative approach to these questions . We have avoided using equations and statistical notations ; interested readers will find implementations of the described methods in the listed references . We focus here on the quantitative synthesis of reports of r and omized , controlled , therapeutic trials because far more meta-analyses on therapeutic studies than on other types of studies have been published . For practical reasons , we present a stepwise description of the tasks that are performed when statistical methods are used to combine data . These tasks are 1 ) deciding whether to combine data and defining what to combine , 2 ) evaluating the statistical heterogeneity of the data , 3 ) estimating a common effect , 4 ) exploring and explaining heterogeneity , 5 ) assessing the potential for bias , and 6 ) presenting the results . Deciding Whether To Combine Data and Defining What To Combine By the time one performs a quantitative synthesis , certain decisions should already have been made about the formulation of the question and the selection of included studies . These topics were discussed in two previous articles in this series [ 1 , 2 ] . Statistical tests can not compensate for lack of common sense , clinical acumen , and biological plausibility in the design of the protocol of a meta- analysis . Thus , a reader of a systematic review should always address these issues before evaluating the statistical methods that have been used and the results that have been generated . Combining poor- quality data , overly biased data , or data that do not make sense can easily produce unreliable results . The data to be combined in a meta- analysis are usually either binary or continuous . Binary data involve a yes/no categorization ( for example , death or survival ) . Continuous data take a range of values ( for example , change in diastolic blood pressure after antihypertensive treatment , measured in mm Hg ) . When one is comparing groups of patients , binary data can be summarized by using several measures of treatment effect that were discussed earlier in this series [ 3 ] . These measures include the risk ratio ; the odds ratio ; the risk difference ; and , when study duration is important , the incidence rate . Another useful clinical measure , the number needed to treat ( NNT ) , is derived from the inverse of the risk difference [ 3 ] . Treatment effect measures , such as the risk ratio and the odds ratio , provide an estimate of the relative efficacy of an intervention , whereas the risk difference describes the intervention 's absolute benefit . The various measures of treatment effect offer complementary information , and all should be examined [ 4 ] . Continuous data Output:

US-CNB is a superior diagnostic technique to US-FNA for axillary staging in breast cancer

MS2_1shot423

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Objectives : To compare the success and complication rates of sonography-guided supine percutaneous nephrolithotomy ( PCNL ) versus prone st and ard technique ( fluoroscopic guidance ) in a r and omized controlled trial . Subjects and Methods : Between April 2009 and August 2011 , 92 c and i date s for PCNL were r and omly divided into two groups : 46 B-mode sonography-guided supine PCNL ( group A ) and 46 st and ard fluoroscopic-guided prone PCNL ( group B ) . Demographic , clinical and perioperative patient characteristics were analyzed , and complications and success rates were compared between the two approaches . Results : Preoperative parameters were comparable in the two groups . The primary success rate was 79.0 and 65.2 % in groups A and B , respectively , after one session of PCNL ( p = 0.485 ) . Sonography-guided access failed in 3 cases ( failure rate 6.5 % in group A vs. 0 % in group B ) . Mean hospital stay ( 2.48 days for group A vs. 2.95 days for group B ; p = 0.039 ) and mean nephrostomy tube stay time ( 1.79 days for group A vs. 2.56 days for group B ; p = 0.007 ) were significantly prolonged in the st and ard technique . Postoperative fever was more prevalent in the st and ard PCNL group ( p = 0.024 ) , but no significant difference was observed in other complications between the two groups . Conclusion : In this study , sonography-guided supine PCNL was presented as a safe and effective technique , similar to st and ard PCNL , with comparable success and complication rates . In addition , using this technique eliminates the possible harmful impacts of radiation on the surgical team and decreases postoperative fever BACKGROUND AND PURPOSE Gaining access to the pyelocaliceal system in percutaneous nephrolithotomy ( PCNL ) is routinely performed using fluoroscopic guidance with the patient in a prone position . We compared ultrasonography-guided access for PCNL with the patient in the flank position with conventional fluoroscopy-guided access . PATIENTS AND METHODS A total of 60 patients were r and omly separated into two 30-patient groups -- namely , ultrasonography-guided access with the patient in the flank position as group 1 , and fluoroscopy-guided access with the patient in the prone position as group 2 . In group 1 , the entire procedure was performed under ultrasonography guidance . RESULTS Successful access was achieved 100 % in both groups . The success rate was 86.7 % in group 1 and 90 % in group 2 ( P = 0.45 ) . The residual stone rate ( stone > or=4 mm ) was 13.3 % in group 1 and 10 % in group 2 . The access duration was 14.5 + /- 2.6 minutes and 9.4 + /- 2.3 minutes in groups 1 and 2 , respectively ( P < 0.05 ) . No significant differences for complications without any adjacent injuries were detected in both groups . Furthermore , the average hospital stay was 2.7 + /- 0.3 and 2.9 + /- 0.3 days accordingly for groups 1 and 2 ( P = 0.89 ) . CONCLUSION Ultrasonography has a high ability to access calculi more easily through the pyelocaliceal system with the patient in the flank position . It is convenient for urologists , and the return to the supine position is possible easily when necessary . Besides , PCNL under ultrasonography guidance and with the patient in the flank position has high success rates and limited complications ; hence , we recommend this technique as an alternative procedure for fluoroscopy-guided PCNL ABSTRACT Introduction and Hypothesis : To compare complications and outcomes of complete supine percutaneous nephrolithotomy ( csPCNL ) with ultrasound guided and fluoroscopically guided procedure . Material s and Methods : In this r and omized clinical trial study from January 2009 to September 2010 , 26 of 51 patients with renal stones underwent csPCNL with ultrasonographic guidance in all steps of the procedure ( group A ) , and the other 25 patients underwent st and ard fluoroscopically guided csPCNL ( group B ) . All of the patients underwent PCNL in the complete supine position . Statistical analysis was performed with SPSS16 software . Results : Mean BMI was 28.14 in group A and 26.31 in group B ( p=0.30 ) . The mean stone burden was 26.48 and 30.44 in groups A and B , respectively ( p=0.20 ) . The stone free rate was 88.5 % in group A and 75.5 % in group B , that was no significant ( p=0.16 ) . Overall 2 patients ( 7.7 % ) in group A and 6 patients ( 24 % ) in group B had complications ( p=0.11 ) . Mean operative time in group A was 88.46 minutes , and in group B it was 79.58 minutes ( p=0.39 ) . Mean hospital stay was 69.70 and 61.79 hours in group A and B , respectively ( p=0.22 ) . There was no visceral injury in groups . Conclusions : This r and omized study showed that totally ultrasonic had the same outcomes of fluoroscopically csPCNL . Ultrasonography can be an alternative rather than fluoroscopy in PCNL . We believe that more r and omized studies are needed to allow endourologists to use sonography rather than fluoroscopy in order to avoid exposition to radiation Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more INTRODUCTION Over the past 20 years , the use of fluoroscopy to guide urologic surgical interventions has been constantly growing . Thus , in their daily practice , urologists and other operating room ( OR ) staff are exposed to X-radiation increasingly frequently . This raises questions as to the risks they encounter and the actions needed to reduce them . OBJECTIVE Evaluate X-ray dose exposure in the members of the surgical team and determine urologist radioprotection knowledge and practice s. MATERIAL S AND METHODS A prospect i ve bicenter study was conducted within AFUF ( French urology resident association ) and in association with The French Nuclear Safety Authority/The Institute for Radiological Protection and Nuclear Safety ( ASN/IRSN ) . Radiation exposure was measured on 12 operators using dosimeters ( seven per operator ) , in staff-occupied locations in the OR using ionization chambers , and on anthropomorphic phantoms . A survey was used to gather information on radiation knowledge and safety practice s of the AFUF members . RESULTS Annual whole-body radiation doses were low ( 0.1 - 0.8 millisieverts [ mSv ] , mostly at around 0.3 mSv ) , and equivalent doses were low for the fingers ( 0.7 - 15 mSv , mostly at around 2.5 mSv ) , and low for the lens of the eye ( 0.3 - 2.3 mSv , mostly at around 0.7 mSv ) . In percutaneous nephrolithotomy , extremity doses were lower when the patient was placed in dorsal decubitus compared with ventral decubitus . Pulsed fluoroscopy reduced radiation dose exposure by a factor of 3 compared with continuous fluoroscopy with no image quality loss . Radiation safety practice s were poor : only 15 % of urologists wore dosimeters and only 5 % had been trained in the h and ling of X-ray generators . CONCLUSION In the present study , radiation exposure for urologists was low , but so was knowledge of radiation safety and optimization practice s. This absence of training for radiation safety and reduction , teamed with novel techniques involving long fluoroscopy-guided interventions , could result in unnecessarily high exposure for patients and OR personnel PURPOSE Achieving access to the pyelocaliceal system in percutaneous nephrolithotomy ( PCNL ) is routinely performed using fluoroscopic guidance . We compared ultrasonography-guided access for PCNL with conventional fluoroscopy-guided access . PATIENTS AND METHODS In a clinical trial , 100 patients with no abnormality of the upper urinary tract were selected from among c and i date s for PCNL and r and omly assigned to two 50-patient groups : ultrasonography-guided access ( group 1 ) versus fluoroscopy-guided access ( group 2 ) . In group 1 , location of the target calix was identified in the transverse and sagittal planes by real-time ultrasonography when patients were in the prone position . Puncture of the target calix was attempted with a Chiba needle attached to the side of the ultrasound probe . If access to the collecting system was achieved , the site of puncture was controlled using fluoroscopy . In group 2 , access was achieved using fluoroscopy guidance . Tract dilatation and stone extraction were the same in both groups . The mean age of patients was 40.7 + /- 12 years and 41.6 + /- 13.7 years in groups 1 and 2 , respectively ( P = 0.4 ) . The male to female ratio in groups 1 and 2 was 34/16 and 31/19 , respectively ( P = 0.5 ) . RESULTS On average , duration of access was 11 + /- 3.5 minutes and 5.5 + /- 1.7 minutes in groups 1 and 2 , respectively ( P = 0.0001 ) . Duration of radiation exposure , on average , was 0.69 + /- 0.26 minutes and 0.95 + /- 0.44 minutes in groups 1 and 2 , respectively ( P = 0.0001 ) . CONCLUSION Access for PCNL using ultrasonography guidance is an acceptable alternative to fluoroscopy and decreases radiation hazards Abstract Objective : To assess the effectiveness and advantages of ultra-mini-percutaneous nephrolithotomy ( UM-PCNL ) versus st and ard PCNL ( S-PCNL ) , as one of the most important differences between the various PCNL techniques is the size of the renal access , which contributes to the broad spectrum of complications and outcomes . Patients and methods : This clinical r and omised trial was conducted in 2016 . In all , 70 patients with renal or upper ureteric stones of 10–20 mm in diameter , who were c and i date s for PCNL , were divided equally into two groups . Group A , underwent UM-PCNL using a 9.8-F ureteroscope through a 16-F sheath ; and Group B , underwent S-PCNL using a 24-F nephroscope through a 30-F sheath . The stones were fragmented by pneumatic lithotripsy . Any perioperative complications and need for analgesia were recorded , and postoperative pain was assessed in both groups using a visual analogue scale ( VAS ) . Results : There were statistically significant differences in postoperative haemoglobin values , haemoglobin drop , transfusion rate , duration of hospitalisation and postoperative VAS pain score between the groups ( P < 0.05 ) . There were no significant differences in operation time , need for auxiliary procedures or stone-free rate . Conclusion : A minimally invasive UM-PCNL using a 9.8-F ureteroscope can play an important role in the treatment of symptomatic renal and upper ureteric stones of < 20 mm in diameter with lesser blood loss , duration of hospitalisation , need of transfusion , and postoperative pain compared with S-PCNL Background : In this study , we aim ed to explore the effect of ultrasound-guided percutaneous nephrolithotomy ( UGPN ) for the treatment in patients with kidney stones ( KS ) . Methods : We r and omly assigned 86 patients with KS to a UGPN group or a control group , each group comprising 43 patients . Patients from the UGPN group underwent UGPN whereas those from control group underwent fluoroscopic-guided percutaneous nephrolithotomy ( FGPN ) . The primary outcome included the stone-free rate . Secondary outcomes included complication rates , operative time , and length of hospitalization . Results : UGPN did not show better efficacy than the FGPN procedure in decreasing stone-free rate ( UGPN group 79.1 % vs control group 69.8 % , P = .45 ) , operative time ( UGPN group 108.4 ± 31.7 minute vs control group 113.2 ± 34.5 minute , P = .50 ) , and length of hospitalization ( UGPN group 2.7 ± 1.3 days vs control group 3.1 ± 1.5 days , P = .19 ) . Additionally , no complications , except fever ( UGPN group 4.7 % vs control group 9.3 % , P = .41 ) and hemoglobin slightly reduced ( UGPN group 7.0 % vs control group 11.6 % , P = .46 ) were noted in patients from both groups in this study . Conclusions : To summarize , we demonstrated that both UGPN and FGPN techniques showed similar efficacy and complications when used for the management of KS OBJECTIVE To examine the cost factors associated with ultrasound and fluoroscopic guidance for percutaneous nephrolithotomy ( PCNL ) and to determine which method can be performed at a lower cost per case . METHODS A cost comparison study was performed utilizing clinical data Output:

Conclusions UG-PCNL is as effective as FG-PCNL and has the advantage of lower complication rates . In addition , UG-PCNL could be performed with patients in the supine position without compromising its efficacy

MS2_1shot424

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Background and Purpose — Pilot studies have suggested benefit from intravenous administration of bone marrow mononuclear stem cells ( BMSCs ) in stroke . We explored the efficacy and safety of autologous BMSCs in subacute ischemic stroke . Methods — This was a phase II , multicenter , parallel group , r and omized trial with blinded outcome assessment that included 120 patients . Patients with subacute ischemic stroke were r and omly assigned to the arm that received intravenous infusion of autologous BMSCs or to control arm . Co primary clinical efficacy outcomes were Barthel Index score and modified Rankin scale at day 180 . Secondary outcomes were change in infa rct volume , National Institute of Health Stroke Scale ( NIHSS ) at day 90 and 180 . Main safety outcomes were adverse events , any new area of 18fluorodeoxyglucose positron emission tomography uptake in any body part over 365 days . Results — Fifty-eight patients received a mean of 280.75 million BMSCs at median of 18.5 days after stroke onset . There was no significant difference between BMSCs arm and control arm in the Barthel Index score ( 63.1 versus 63.6 ; P=0.92 ) , modified Rankin scale shift analysis ( P=0.53 ) or score > 3 ( 47.5 % versus 49.2 % ; P=0.85 ) , NIHSS score ( 6.3 versus 7.0 ; P=0.53 ) , change in infa rct volume ( −11.1 versus −7.36 ; P=0.63 ) at day 180 . Adverse events were also similar in the 2 arms , and no patient showed any new area of 18fluorodeoxyglucose uptake . Conclusions — With the methods used , results of this hitherto first r and omized controlled trial indicate that intravenous infusion of BMSCs is safe , but there is no beneficial effect of treatment on stroke outcome . Clinical Trial Registration — URLs : http://ctri.nic.in/ Clinical trials and http://www . clinical trials.gov . Unique identifiers : CTRI-ROVCTRI/2008/091/0004 and NCT0150177 BACKGROUND The influence of poststroke depression on long-term survival is poorly investigated . Thus , we aim ed to evaluate the influence of major depression disorder ( MDD ) on long-term survival in the participants from The Study of Stroke Mortality and Morbidity in Adults ( EMMA Study ) in São Paulo , Brazil . METHODS We prospect ively evaluated ischemic and hemorrhagic stroke ( HS ) cases from the EMMA Study . Baseline and stroke characteristics and cardiovascular risk factors were evaluated according to MDD assessed by the Patient Health Question naire , which was applied 30 days after index event and periodically during 1-year follow-up . We performed Kaplan-Meier survival analysis , as well as crude and multiple Cox proportional hazards models . RESULTS In this subset of the EMMA Study , we evaluated 164 ( 85.9 % ) patients with ischemic stroke and 27 ( 14.1 % ) with HS . Among these , overall incidence of MDD was 25.1 % during 1 year of follow-up , regardless stroke subtype . The peak rate of major depression postacute event was beyond 1 month . We observed a lower survival rate among individuals who developed poststroke MDD than among those who did not develop this condition after 1 year of follow-up ( 85.4 % versus 96.5 % , log rank P = .006 ) . After multiple analysis , we kept a higher risk of all-cause mortality among those who developed MDD compared to participants without MDD ( hazard ratio = 4.60 , 95 % confidence interval = 1.36 - 15.55 , P = .01 ) . CONCLUSION Our findings suggest that incident MDD is a potential marker of poor prognosis 1 year after stroke Background and Purpose — Pre clinical data suggest that cell-based therapies have the potential to improve stroke outcomes . Methods — Eighteen patients with stable , chronic stroke were enrolled in a 2-year , open-label , single-arm study to evaluate the safety and clinical outcomes of surgical transplantation of modified bone marrow – derived mesenchymal stem cells ( SB623 ) . Results — All patients in the safety population ( N=18 ) experienced at least 1 treatment-emergent adverse event . Six patients experienced 6 serious treatment-emergent adverse events ; 2 were probably or definitely related to surgical procedure ; none were related to cell treatment . All serious treatment-emergent adverse events resolved without sequelae . There were no dose-limiting toxicities or deaths . Sixteen patients completed 12 months of follow-up at the time of this analysis . Significant improvement from baseline ( mean ) was reported for : ( 1 ) European Stroke Scale : mean increase 6.88 ( 95 % confidence interval , 3.5–10.3 ; P<0.001 ) , ( 2 ) National Institutes of Health Stroke Scale : mean decrease 2.00 ( 95 % confidence interval , −2.7 to −1.3 ; P<0.001 ) , ( 3 ) Fugl-Meyer total score : mean increase 19.20 ( 95 % confidence interval , 11.4–27.0 ; P<0.001 ) , and ( 4 ) Fugl-Meyer motor function total score : mean increase 11.40 ( 95 % confidence interval , 4.6–18.2 ; P<0.001 ) . No changes were observed in modified Rankin Scale . The area of magnetic resonance T2 fluid-attenuated inversion recovery signal change in the ipsilateral cortex 1 week after implantation significantly correlated with clinical improvement at 12 months ( P<0.001 for European Stroke Scale ) . Conclusions — In this interim report , SB623 cells were safe and associated with improvement in clinical outcome end points at 12 months . Clinical Trial Registration — URL : https://www . clinical trials.gov . Unique identifier : NCT01287936 PURPOSE Bone marrow stem cells ( BMSC ) were transplanted into the perilesional area in five patients bearing sequels of stroke , to evaluate the safety of the procedure and tolerance to the transplanted cells . METHODS Cells were obtained from bone marrow sample s taken from the same patient and stereotactically implanted into the targets , determined using a combination of images , and trans-operative recording of multiunit activity . The cells were implanted in several points along tracts in the perilesional region . RESULTS No important adverse events derived from surgery or transplant were observed during the one year follow-up period , or detected using a combination of tests and functional measurements applied pre- and post-surgically . In contrast , some improvements were observed regarding the neurological condition of the patients , but the small number of patients in the study does not allow any conclusive statement . CONCLUSIONS Our results demonstrate that BMSC can be safely transplanted into the brain of patients , with excellent tolerance and without complications , using the methods described here Stem cell therapy is an emerging therapeutic modality in the treatment of stroke . We assessed the safety and feasibility of the cotransplantation of neural stem/progenitor cells ( NSPCs ) and mesenchymal stromal cells ( MSCs ) in patients with ischemic stroke . Eight patients were enrolled in this study . All patients had a hemisphere with infa rct lesions located on one side of the territories of the cerebral middle or anterior arteries as revealed with cranial magnetic resonance imaging ( MRI ) . The patients received one of the following two types of treatment : the first treatment involved four intravenous injections of MSCs at 0.5 × 106/kg body weight ; the second treatment involved one intravenous injection of MSCs at 0.5 × 106/kg weight followed by three injections of MSCs at 5 × 106/patient and NSPCs at 6 × 106/patient through the cerebellomedullary cistern . The patients ' clinical statuses were evaluated with the National Institutes of Health Stroke Scale ( NIHSS ) , the modified Rankin Scale ( mRS ) , and the Barthel index ( BI ) . Six patients were given four cell transplantations . The most common side effect of stem cell transplantation in these six cases was low fever that usually lasted 2–4 days after each therapy . One patient exhibited minor dizziness . All side effects appeared within the first 2–24 h of cell transplantation , and they resolved without special treatment . There was no evidence of neurological deterioration or neurological infection . Most importantly , no tumorigenesis was found at a 2-year follow-up . The neurological functions , disability levels , and daily living abilities of the patients in this study were improved . While these observations support the use of the combination transplantation of NSPCs and MSCs as a safe and feasible method of improving neurological function , further studies that include larger sample s , longer follow-ups , and control groups are still needed . This manuscript is published as part of the International Association of Neurorestoratology ( IANR ) special issue of Cell Transplantation The goal of this clinical trial was to assess the feasibility and safety of transplanting autologous bone marrow mononuclear cells into patients suffering severe embolic stroke . Major inclusion criteria included patients with cerebral embolism , age 20–75 years , National Institute of Health Stroke Scale ( NIHSS ) score displaying improvement of ≤5 points during the first 7 days after stroke , and NIHSS score of ≥10 on day 7 after stroke . Bone marrow aspiration ( 25 or 50 mL ; N = 6 patients in each case ) was performed 7–10 days poststroke , and bone marrow mononuclear cells were administrated intravenously . Mean total transplanted cell numbers were 2.5 × 108 and 3.4 × 108 cells in the lower and higher dose groups , respectively . No apparent adverse effects of administering bone marrow cells were observed . Compared with the lower dose , patients receiving the higher dose of bone marrow cells displayed a trend toward improved neurologic outcomes . Compared with 1 month after treatment , patients receiving cell therapy displayed a trend toward improved cerebral blood flow and metabolic rate of oxygen consumption 6 months after treatment . In comparison with historical controls , patients receiving cell therapy had significantly better neurologic outcomes . Our results indicated that intravenous transplantation of autologous bone marrow mononuclear cells is safe and feasible . Positive results and trends favoring neurologic recovery and improvement in cerebral blood flow and metabolism by cell therapy underscore the relevance of larger scale r and omized controlled trials using this approach Article abstract Transplantation of cultured neuronal cells is safe in animal models and improves motor and cognitive deficits in rats with stroke . The authors studied the safety and feasibility of human neuronal cellular transplantation in patients with basal ganglia stroke and fixed motor deficits , including 12 patients ( aged 44 to 75 years ) with an infa rct 6 months to 6 years previously ( stable for at least 2 months ) . Serial evaluations ( 12 to 18 months ) showed no adverse cell-related serologic or imaging-defined effects . The total European Stroke Scale score improved in six patients ( 3 to 10 points ) , with a mean improvement 2.9 points in all patients ( p = 0.046 ) . Six of 11 PET scans at 6 months showed improved fluorodeoxyglucose uptake at the implant site . Neuronal transplantation is feasible in patients with motor infa rct ion Transplantation of human mesenchymal stem cells has been shown to reduce infa rct size and improve functional outcome in animal models of stroke . Here , we report a study design ed to assess feasibility and safety of transplantation of autologous human mesenchymal stem cells exp and ed in autologous human serum in stroke patients . We report an unblinded study on 12 patients with ischaemic grey matter , white matter and mixed lesions , in contrast to a prior study on autologous mesenchymal stem cells exp and ed in foetal calf serum that focused on grey matter lesions . Cells cultured in human serum exp and ed more rapidly than in foetal calf serum , reducing cell preparation time and risk of transmissible disorders such as bovine spongiform encephalomyelitis . Autologous mesenchymal stem cells were delivered intravenously 36 - 133 days post-stroke . All patients had magnetic resonance angiography to identify vascular lesions , and magnetic resonance imaging prior to cell infusion and at intervals up to 1 year after . Magnetic resonance perfusion-imaging and 3D-tractography were carried out in some patients . Neurological status was scored using the National Institutes of Health Stroke Scale and modified Rankin scores . We did not observe any central nervous system tumours , abnormal cell growths or neurological deterioration , and there was no evidence for venous thromboembolism , systemic malignancy or systemic infection in any of the patients following stem cell infusion . The median daily rate of National Institutes of Health Stroke Scale change was 0.36 during the first week post-infusion , compared with a median daily rate of change of 0.04 from the first day of testing to immediately before infusion . Daily rates of change in National Institutes of Health Stroke Scale scores during longer post-infusion intervals that more closely matched the interval between initial scoring and cell infusion also showed an increase following cell infusion . Mean lesion volume as assessed by magnetic resonance imaging was reduced by > 20 % at 1 week post-cell infusion . While we would emphasize that the current study was unblinded , did not assess overall function or relative functional importance of different types of deficits , and does not exclude placebo effects or Output:

While majority of the pre- clinical and clinical studies demonstrated statistically significant effects , the clinical significance of these findings was still unclear . Addressing these issues and incorporating changes into future animal studies and human trials may lead to better success of stem cells-based therapeutics in the near future

MS2_1shot425

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Summary Background In the Medical Research Council ( MRC ) COIN trial , the epidermal growth factor receptor (EGFR)-targeted antibody cetuximab was added to st and ard chemotherapy in first-line treatment of advanced colorectal cancer with the aim of assessing effect on overall survival . Methods In this r and omised controlled trial , patients who were fit for but had not received previous chemotherapy for advanced colorectal cancer were r and omly assigned to oxaliplatin and fluoropyrimidine chemotherapy ( arm A ) , the same combination plus cetuximab ( arm B ) , or intermittent chemotherapy ( arm C ) . The choice of fluoropyrimidine therapy ( capecitabine or infused fluouroracil plus leucovorin ) was decided before r and omisation . R and omisation was done central ly ( via telephone ) by the MRC Clinical Trials Unit using minimisation . Treatment allocation was not masked . The comparison of arms A and C is described in a companion paper . Here , we present the comparison of arm A and B , for which the primary outcome was overall survival in patients with KRAS wild-type tumours . Analysis was by intention to treat . Further analyses with respect to NRAS , BRAF , and EGFR status were done . The trial is registered , IS RCT N27286448 . Findings 1630 patients were r and omly assigned to treatment groups ( 815 to st and ard therapy and 815 to addition of cetuximab ) . Tumour sample s from 1316 ( 81 % ) patients were used for somatic molecular analyses ; 565 ( 43 % ) had KRAS mutations . In patients with KRAS wild-type tumours ( arm A , n=367 ; arm B , n=362 ) , overall survival did not differ between treatment groups ( median survival 17·9 months [ IQR 10·3–29·2 ] in the control group vs 17·0 months [ 9·4–30·1 ] in the cetuximab group ; HR 1·04 , 95 % CI 0·87–1·23 , p=0·67 ) . Similarly , there was no effect on progression-free survival ( 8·6 months [ IQR 5·0–12·5 ] in the control group vs 8·6 months [ 5·1–13·8 ] in the cetuximab group ; HR 0·96 , 0·82–1·12 , p=0·60 ) . Overall response rate increased from 57 % ( n=209 ) with chemotherapy alone to 64 % ( n=232 ) with addition of cetuximab ( p=0·049 ) . Grade 3 and higher skin and gastrointestinal toxic effects were increased with cetuximab ( 14 vs 114 and 67 vs 97 patients in the control group vs the cetuximab group with KRAS wild-type tumours , respectively ) . Overall survival differs by somatic mutation status irrespective of treatment received : BRAF mutant , 8·8 months ( IQR 4·5–27·4 ) ; KRAS mutant , 14·4 months ( 8·5–24·0 ) ; all wild-type , 20·1 months ( 11·5–31·7 ) . Interpretation This trial has not confirmed a benefit of addition of cetuximab to oxaliplatin-based chemotherapy in first-line treatment of patients with advanced colorectal cancer . Cetuximab increases response rate , with no evidence of benefit in progression-free or overall survival in KRAS wild-type patients or even in patients selected by additional mutational analysis of their tumours . The use of cetuximab in combination with oxaliplatin and capecitabine in first-line chemotherapy in patients with widespread metastases can not be recommended . Funding Cancer Research UK , Cancer Research Wales , UK Medical Research Council , Merck PURPOSE Microsatellite instability ( MSI ) , TP53 mutation , and KRAS mutation status have been reported as prognostic factors in colon cancer . Most studies , however , have included heterogeneous groups of patients with respect to cancer stage . We determined the prognostic relevance of high-frequency MSI ( MSI-H ) , TP53 mutations , and KRAS mutations in a well-defined group of patients with stage III colon cancer ( N = 391 ) , r and omly assigned for adjuvant treatment with fluorouracil-based chemotherapy . METHODS Three hundred ninety-one tumor specimens were available . MSI was determined in 273 specimens , and mutation analyses of TP53 and KRAS were performed in 220 and 205 specimens , respectively . RESULTS In a univariate analysis , MSI-H ( 44 of 273 ; 16 % ) was associated with a longer disease-free survival ( DFS ; P = .038 ) , but in a multivariate model adjusting for nodal involvement , histology , invasion , and grade of tumor , the association of MSI status with DFS did no longer reach statistical significance , though the risk estimate for microsatellite stability versus MSI-H tumors did not change much . Mutant TP53 , found in 116 ( 53 % ) of 220 tumors , was associated with a shorter DFS , both in univariate ( P = .009 ) and multivariate analyses ( P = .018 ) , whereas KRAS mutations ( 58 of 205 ; 28 % ) did not show any prognostic significance . CONCLUSION Both mutant TP53 and MSI-H seem to be prognostic indicators for disease-free survival , but only TP53 retains statistical significance after adjusting for clinical heterogeneity . Thus , in adjuvantly treated patients with stage III colon cancer , presence or absence of a TP53 mutation should be considered as a better predictor for DFS than MSI status Output:

Interpretation Metastatic CRC demonstrates high concordance across multiple biomarkers , suggesting that molecular testing of either the primary or liver and lung metastasis is adequate .

MS2_1shot426

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: OBJECTIVES This study assessed the effectiveness of a smoking cessation program for women in public health clinics , controlling for reported exposures to 4 common intervention components ( provider advice , booklet , video segment , posters ) among smokers in the control group . METHODS After a baseline control period , 10 pair-matched clinics were r and omly assigned to study groups . A total of 1042 smokers in the combined baseline and control groups and 454 smokers in the intervention group completed a preintervention question naire and a postintervention telephone interview 5 to 8 weeks later . Eight smoking outcomes , including quitting , were analyzed for the effect of reported exposure to intervention components , experimental program , and clinic service . RESULTS Greater exposure to intervention components , being in the experimental program , and being seen in prenatal clinics independently improved smoking outcomes . CONCLUSIONS The number of interventions reported by smokers in the control group ranged from none to 4 and varied across clinic services . The experimental program we tested produced better outcomes than the minimal smoking cessation interventions already existing in the control clinics , after we controlled for whether smokers were or were not exposed to these interventions BACKGROUND Because smoking has a profound impact on socioeconomic disparities in illness and death , it is crucial that vulnerable population s of smokers be targeted with treatment . The U.S. Public Health Service recommends that all patients be asked about their smoking at every visit and that smokers be given brief advice to quit and referred to treatment . PURPOSE Initiatives to facilitate these practice s include the 5A 's ( ask , advise , assess , assist , arrange ) and Ask-Advise-Refer ( AAR ) . Unfortunately , primary care referrals are low , and most smokers referred fail to enroll . This study evaluated the efficacy of the Ask-Advise-Connect ( AAC ) approach to linking smokers with treatment in a large , safety net public healthcare system . DESIGN The study design was a pair-matched group-r and omized trial with two treatment arms . SETTING / PARTICIPANTS Ten safety net clinics in Houston TX . INTERVENTION Clinics were r and omized to AAC ( n=5 ; intervention ) or AAR ( n=5 ; control ) . Licensed vocational nurses ( LVNs ) were trained to assess and record the smoking status of all patients at all visits in the electronic health record . Smokers were given brief advice to quit . In AAC , the names and phone numbers of smokers who agreed to be connected were sent electronically to the Texas quitline daily , and patients were proactively called by the quitline within 48 hours . In AAR , smokers were offered a quitline referral card and encouraged to call on their own . Data were collected between June 2010 and March 2012 and analyzed in 2012 . MAIN OUTCOME MEASURES The primary outcome was impact , defined here as the proportion of identified smokers that enrolled in treatment . RESULTS The impact ( proportion of identified smokers who enrolled in treatment ) of AAC ( 14.7 % ) was significantly greater than the impact of AAR ( 0.5 % ) , t(4)=14.61 , p=0.0001 , OR=32.10 ( 95 % CI=16.60 , 62.06 ) . CONCLUSIONS The AAC approach to aiding smoking cessation has tremendous potential to reduce tobacco-related health disparities Smoking cessation treatment is now integrated into many health-care systems and a major research effort is under way to improve current success rates . Until now results from r and omized clinical trials have been reported in many different ways , leading to problems of interpretation . We propose six st and ard criteria comprising the ' Russell St and ard ' ( RS ) . These criteria are applicable to trials of cessation aids where participants have a defined target quit date and there is face-to-face contact with research ers or clinic staff , as follows . ( 1 ) Follow-up for 6 months ( RS6 ) or 12 months ( RS12 ) from the target quit date or the end of a predefined ' grace period ' ; ( 2 ) self-report of smoking abstinence over the whole follow-up period allowing up to five cigarettes in total ; ( 3 ) biochemical verification of abstinence at least at the 6-month or 12-month follow-up point ; ( 4 ) use of an ' intention-to-treat ' approach in which data from all r and omized smokers are included in the analysis unless they have died or moved to an untraceable address ( participants who are included in the analysis are counted as smokers if their smoking status at the final follow-up can not be determined ) ; ( 5 ) following-up ' protocol violators ' and using their true smoking status in the analysis ; and ( 6 ) collecting follow-up data blind to smokers ' allocation to trial group . We believe that these criteria provide the best compromise between practicability and surrogacy for long-term cessation and will enable meaningful comparison between studies . There may be good reasons why other outcome criteria would also be reported , and studies that involve interventions with special groups or where there is no design ated target quit date or face to face contact would need to adapt these criteria accordingly Background Argentina and Uruguay are among the countries with the highest proportion of pregnant women who smoke . The implementation of an effective smoking cessation intervention would have a significant impact on the health of mothers and infants . The “ 5 A ’s ” ( Ask , Advise , Assess , Assist , Arrange ) is a strategy consisting of a brief cessation counseling session of 5–15 minutes delivered by a trained provider . The “ 5 A ’s ” is considered the st and ard of care worldwide ; however , it is under used in Argentina and Uruguay . Methods We will conduct a two-arm , parallel cluster r and omized controlled trial of an implementation intervention in 20 prenatal care setting s in Argentina and Uruguay . Prenatal care setting s will be r and omly allocated to either an intervention or a control group after a baseline data collection period . Midwives ’ facilitators in the 10 intervention prenatal clinics ( clusters ) will be identified and trained to deliver the “ 5 A ’s ” to pregnant women and will then disseminate and implement the program . The 10 clusters in the control group will continue with their st and ard in-service activities . The intervention will be tailored by formative research to be readily applicable to local prenatal care services at maternity hospitals and acceptable to local pregnant women and health providers . Our primary hypothesis is that the intervention is feasible in prenatal clinics in Argentina and Uruguay and will increase the frequency of women receiving tobacco use cessation counseling during pregnancy in the intervention clinics compared to the control clinics . Our secondary hypotheses are that the intervention will decrease the frequency of women who smoke by the end of pregnancy , and that the intervention will increase the attitudes and readiness of midwives towards providing counseling to women in the intervention clinics compared to the control clinics . Trial registration Clinical Trials.gov . Identifier : Background Extended smoking cessation follow-up after hospital discharge significantly increases abstinence . Hospital smoke-free policies create a period of ‘ forced abstinence ’ for smokers , thus providing an opportunity to integrate tobacco dependence treatment , and to support post-discharge maintenance of hospital-acquired abstinence . This study is funded by the National Heart , Lung , and Blood Institute ( 1U01HL1053231 ) . Methods / Design The Inpatient Technology-Supported Assisted Referral study is a multi-center , r and omized clinical effectiveness trial being conducted at Kaiser Permanente Northwest ( KPNW ) and at Oregon Health & Science University ( OHSU ) hospitals in Portl and , Oregon . The study assesses the effectiveness and cost-effectiveness of linking a practical inpatient assisted referral to outpatient cessation services plus interactive voice recognition ( AR + IVR ) follow-up calls , compared to usual care inpatient counseling ( UC ) . In November 2011 , we began recruiting 900 hospital patients age ≥18 years who smoked ≥1 cigarettes in the past 30 days , willing to remain abstinent postdischarge , have a working phone , live within 50 miles of the hospital , speak English , and have no health-related barriers to participation . Each site will r and omize 450 patients to AR + IVR or UC using a 2:1 assignment strategy . Participants in the AR + IVR arm will receive a brief inpatient cessation consult plus a referral to available outpatient cessation programs and medications , and four IVR follow-up calls over seven weeks postdischarge . Participants do not have to accept the referral . At KPNW , UC participants will receive brief inpatient counseling and encouragement to self-enroll in available outpatient services . The primary outcome is self-reported thirty-day smoking abstinence at six months postr and omization for AR + IVR participants compared to usual care . Additional outcomes include self-reported and biochemically confirmed seven-day abstinence at six months , self-reported seven-day , thirty-day , and continuous abstinence at twelve months , intervention dose response at six and twelve months for AR + IVR recipients , incremental cost-effectiveness of AR + IVR intervention compared to usual care at six and twelve months , and health-care utilization and expenditures at twelve months for AR + IVR recipients compared to UC . Discussion This study will provide important evidence for the effectiveness and cost-effectiveness of linking hospital-based tobacco treatment specialists ’ services with discharge follow-up care . Trial Registration Clinical Trials.gov : AIMS Two methods of dissemination ( simple and intensive ) were used to disseminate a smoking cessation programme to doctors and midwives working in antenatal clinics . This paper describes the differential uptake of the smoking cessation programme by doctors and midwives . It investigates whether the number of smoking cessation interventions used differ due to the type of dissemination . It also examines the frequency with which doctors and midwives provide smoking cessation interventions after dissemination . DESIGN Clinics were r and omized to the method of dissemination ( simple or intensive ) . Pre-post test design was used to examine the relationship between dissemination method and professional status at baseline and follow-up . A baseline survey collected data on the use of smoking cessation intervention in the clinics prior to dissemination . A follow-up survey was conducted 18 months after the dissemination . SETTING Twenty-three public hospital antenatal clinics in NSW . PARTICIPANTS All clinical staff ( midwives and doctors ) working in the clinic during the 1 - 2-week survey period prior to dissemination and 18 months after the dissemination were asked to participate . The response rate was 63 % ( 223 ) at baseline and 64 % ( 182 ) at follow-up . Only 48 % of midwives and doctors at follow-up were working in the original clinic . MEASURES The proportion of clinicians who initially adopted the programme ; the proportion of clinicians who had used one or more programme components in the last week ) ; the number of types of smoking cessation intervention provided ( maximum = 13 ) , and the estimated proportion of clients offered smoking cessation intervention . FINDINGS More midwives than doctors " ever used " the programme ( 76 % vs. 25 % ) and continued to implement ( 58 % vs. 22 % ) the programme 18 months after dissemination . Both midwives and doctors increased the number of types of smoking cessation intervention offered at follow-up compared to baseline ( mean difference 2.8 ) . Midwives provided more smoking cessation interventions than doctors at baseline ( mean difference 0.9 ) and at follow-up ( 1.6 ) , regardless of method used to disseminate the programme . Midwives ' mean estimates of the proportion of clients offered interventions were greater than doctors ' ( midwives ' 59 % vs. doctors ' 35 % ) at follow-up . CONCLUSION The dissemination of a smoking cessation programme increased the level of smoking cessation interventions used by doctors and midwives . Doctors and midwives differ in their uptake of smoking cessation programmes . This information can be used to plan programme dissemination strategies in the future BACKGROUND A multicomponent motivational smoking cessation intervention was evaluated in 33 prenatal , family planning , and pediatric services in 12 public health clinics . Clinic-based intervention components were implemented by clinic personnel as part of routine medical visits . METHODS The evaluation design included pre- and postintervention measurements of multiple study outcomes in a baseline ( all clinics prior to the start of the intervention ) and an experimental period ( matchedpair r and om assignment of clinics to intervention or control conditions ) . Subjects were 683 ( baseline ) and 1,064 ( experimental ) smokers with measurements of smoking outcomes at both times . Mixed-effects regressions analyzed individual outcomes clustered within clinics and services . RESULTS Control and intervention clinics had similar outcomes in the baseline period . In the experiment , outcomes improved in the intervention but not in the control clinics . Compared to controls , smokers exposed to the intervention were more likely to have quit ( 14.5 versus 7.7 % ) or take actions toward quitting and had higher mean action , stage of readiness , and motivation to quit scores . These positive effects persisted when clustering within clinics and services was controlled . CONCLUSIONS This intervention , implemented by clinic personnel as part of routine medical visits , was effective under these natural conditions across different types of clinic service STUDY OBJECTIVE To test whether physicians who receive a continuing education program ( " Quit for Life " ) about how to counsel smokers to quit would counsel smokers more effectively and have higher rates of long-term smoking cessation among their patients who smoke . DESIGN R and omized trial with blinded assessment of principal outcomes . SETTING Four health maintenance organization medical centers in northern California . SUBJECTS Eighty-one intern Output:

AUTHORS ' CONCLUSIONS The available evidence suggests that system change interventions for smoking cessation may not be effective in achieving increased cessation rates , but have been shown to improve process outcomes , such as documentation of smoking status , provision of cessation counselling and referral to smoking cessation services .

MS2_1shot427

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Background —Bone-marrow mononuclear cell ( BM-MNC ) implantation improves ischemic symptoms in patients with critical limb ischemia ( CLI ) . The purpose of this study was to evaluate long-term clinical outcomes after autologous BM-MNC implantation in patients with CLI . Methods and Results —We assessed long-term clinical outcomes after BM-MNC implantation in 51 patients with CLI , including 25 patients with peripheral arterial disease ( PAD ) and 26 patients with Buerger disease . Forty-six CLI patients who had no BM-MNC implantation served as control subjects . Median follow-up period was 4.8 years . The 4-year amputation-free rates after BM-MNC implantation were 48 % in PAD patients and 95 % in Buerger disease , and they were 0 % in control PAD patients and 6 % in control Buerger disease . The 4-year overall survival rates after BM-MNC implantation were 76 % in PAD patients and 100 % in Buerger disease , and they were 67 % in control PAD patients and 100 % in control Buerger disease . Multivariable Cox proportional hazards analysis revealed that BM-MNC implantation correlated with prevention of major amputation and that hemodialysis and diabetes mellitus correlated with major amputation . In Buerger disease , ankle brachial pressure index and transcutaneous oxygen pressure were significantly increased after 1 month and remained high during 3-year follow-up . However , in patients with PAD , ankle brachial pressure index and transcutaneous oxygen pressure significantly increased after 1 month and gradually decreased during 3-year follow-up and returned to baseline levels . Conclusions —These findings suggest that BM-MNC implantation is safe and effective in patients with CLI , especially in patients with Buerger disease . Clinical Trial Registration —URL : http://home.hiroshima-u.ac.jp/angio/. Unique identifier : 001769 UNLABELLED The present clinical trial analyzed the safety of gene therapy using plasmidial constructs expressing vascular endothelial and hepatocyte growth factors in patients with critical limb ischemia . The study included 43 patients : 29 in the treatment group and 14 allocated to the placebo group . The primary end points were the rate of major amputations and the clinical safety of the method . Secondary end points were improvement of pain at rest , walking ability and the ankle/brachial pressure index . The overall major amputation rate was 31.04 % in the treatment group and 71.42 % in the placebo group ( p = 0.029 ) . Pain at rest was improved in 65 % of patients in the gene therapy group and in 7 % in the placebo group ( p = 0.0006 ) . There were no significant adverse effects in the treatment group . CONCLUSION Gene therapy with vascular endothelial and hepatocyte growth factors is therapeutically safe and reduces the rate of major amputations and relieves pain at rest in patients with critical limb ischemia OBJECTIVES We have previously reported the results of a dose-finding phase II trial showing that HGF angiogenic gene therapy can increase TcPO2 compared with placebo in patients with critical limb ischemia ( CLI ) . The purpose of this r and omized placebo controlled multi-center trial was to further assess the safety and clinical efficacy of a modified HGF gene delivery technique in patients with CLI and no revascularization options . METHODS Patients with lower extremity ischemic tissue loss ( Rutherford 5 and 6 ) received three sets of eight intramuscular injections every 2 weeks of HGF plasmid under duplex ultrasound guidance . Injection locations were individualized for each patient based on arteriographically defined vascular anatomy . Primary safety end point was incidence of adverse events ( AE ) or serious adverse events ( SAE ) . Clinical end points included change from baseline in toe brachial index ( TBI ) , rest pain assessment by a 10 cm visual analogue scale ( VAS ) as well as wound healing , amputation , and survival at 3 and 6 months . RESULTS R and omization ratio was 3:1 HGF ( n = 21 ) vs placebo ( n = 6 ) . Mean age was 76 ± 2 years , with 56 % male and 59 % diabetic . There was no difference in demographics between groups . There was no difference in AEs or SAEs , which consisted mostly of transient injection site discomfort , worsening of CLI , and intercurrent illnesses . Change in TBI significantly improved from baseline at 6 months in the HGF-treated group compared with placebo ( 0.05 ± 0.05 vs -0.17 ± 0.04 ; P = .047 ) . Change in VAS from baseline at 6 months was also significantly improved in the HGF-treated group compared with placebo ( -1.9 ± 1.3 vs + 0.06 ± 0.2 ; P = .04 ) . Complete ulcer healing at 12 months occurred in 31 % of the HGF group and 0 % of the placebo ( P = .28 ) There was no difference in major amputation of the treated limb ( HGF 29 % vs placebo 33 % ) or mortality at 12 months ( HGF 19 % vs placebo 17 % ) between groups . CONCLUSION HGF gene therapy using a patient vascular anatomy specific delivery technique appears safe , maintained limb perfusion , and decreased rest pain in patients with CLI compared with placebo . A larger study to assess the efficacy of this therapy on more clinical ly relevant end points is warranted Background — The Study to Assess the Safety of Intramuscular Injection of Hepatocyte Growth Factor Plasmid to Improve Limb Perfusion in Patients With Critical Limb Ischemia ( HGF-STAT trial ) determined the effect of hepatocyte growth factor ( HGF ) plasmid on safety and limb tissue perfusion as measured by transcutaneous oxygen tension ( TcPo2 ) in patients with critical limb ischemia ( CLI ) . Methods and Results — R and omized patients with rest pain or ischemic ulcers and TcPo2 < 40 mm Hg and /or toe pressure < 50 mm Hg received placebo or HGF-plasmid intramuscular injection as follows : 0.4 mg at days 0 , 14 , and 28 ( low dose ) ; 4.0 mg at days 0 and 28 ( middle dose ) ; or 4.0 mg at days 0 , 14 , and 28 ( high dose ) . Patients were evaluated for safety , changes in TcPo2 and ankle and toe pressure , amputation , and wound healing . Ninety-three of 104 treated patients were evaluated for safety ( mean age 70 years , 63 % male , 53 % diabetic , 64 % with tissue loss , mean ankle-brachial index 0.41 , and mean toe pressure 26 mm Hg ) . Adverse events occurred in 86 % of the patients , most of which were related to CLI or comorbid conditions and were not different between groups . TcPo2 ( mean±SE ) increased at 6 months in the high-dose group ( 24.0±4.2 mm Hg , 95 % CI 15.5 to 32.4 mm Hg ) compared with the placebo ( 9.4±4.2 mm Hg , 95 % CI 0.9 to 17.8 ) , low-dose ( 11.1±3.7 mm Hg , CI 3.7 to 18.7 mm Hg ) , and middle-dose ( 7.3±4.8 mm Hg , CI −2.2 to 17.0 mm Hg ) groups ( ANCOVA P=0.0015 ) . There was no difference between groups in secondary end points , including ankle-brachial index , toe-brachial index , pain relief , wound healing , or major amputation . Conclusions — Intramuscular injection of HGF plasmid was safe and well tolerated . Larger studies to determine whether HGF plasmid can improve wound healing and limb salvage in patients with CLI are warranted BACKGROUND Patients with intermittent claudication ( IC ) could benefit from low-cost , effective rehabilitative programs . This retrospective study evaluates compliance , impact on Quality of Life ( QoL ) and cost-effectiveness of a hospital prescribed , at-home performed ( Test-in/Train-out ) rehabilitative program for patients with IC . METHODS AND RESULTS Two-hundred and eighty-nine patients with IC ( 71 ± 10.1 years , M = 210 ) were enrolled for a 2-year period . Two daily 10-min home walking sessions at maximal asymptomatic speed were prescribed , with serial check-ups at the hospital . Compliance with the program was assessed by assigning a score of 1 ( lowest compliance ) to 4 ( highest compliance ) . The SF-36 question naire and a constant-load treadmill test were used to evaluate QoL and Initial/Absolute Claudication Distance , respectively . Both direct and indirect costs of the program were considered for cost-effectiveness analysis . Two-hundred and fifty patients ( 70.5 ± 9.2 years , M = 191 ) , at Fontaine 's II-B stage ( 86 % ) , were included in the study . No adverse events were reported . The average compliance score was 3.1 . At discharge , both SF-36 domains and walking performance significantly increased ( P < 0.0001 ) . A total of 1,839 in-hospital check-ups ( 7.36 /patient ) were performed . Direct and indirect costs represented 93 % and 7 % of the total costs , respectively . The average costs of a visit and of a therapy cycle were C68.93 and C507.20 , respectively . The cost to walk an additional meter before stopping was C9.22 . CONCLUSIONS A Test-in/Train-out program provided favourable patient compliance , QoL impact and cost-effectiveness in patients with IC Ixmyelocel-T is a patient-specific , exp and ed , multicellular therapy evaluated in patients with lower extremity critical limb ischemia ( CLI ) with no options for revascularization . This r and omized , double-blind , placebo-controlled , phase 2 trial ( RESTORE-CLI ) compared the efficacy and safety of intramuscular injections of ixmyelocel-T with placebo . Patients received one-time injections over 20 locations in a single leg and were followed for 12 months . Safety assessment s included occurrence of adverse events . Efficacy assessment s included time to first occurrence of treatment failure ( TTF ; major amputation of injected leg ; all-cause mortality ; doubling of total wound surface area from baseline ; de novo gangrene ) and amputation-free survival ( AFS ; major amputation of injected leg ; all-cause mortality ) . A total of 77 patients underwent bone marrow or sham aspiration ; 72 patients received ixmyelocel-T ( 48 patients ) or placebo ( 24 patients ) . Adverse event rates were similar . Ixmyelocel-T treatment led to a significantly prolonged TTF ( P = 0.0032 , logrank test ) . AFS had a clinical ly meaningful 32 % reduction in event rate that was not statistically significant ( P = 0.3880 , logrank test ) . Treatment effect in post hoc analyses of patients with baseline wounds was more pronounced ( TTF : P < 0.0001 , AFS : P = 0.0802 , logrank test ) . Ixmyelocel-T treatment was well tolerated and may offer a potential new treatment option BACKGROUND Patients with critical limb ischaemia have a high rate of amputation and mortality . We tested the hypothesis that non-viral 1 fibroblast growth factor ( NV1FGF ) would improve amputation-free survival . METHODS In this phase 3 trial ( EFC6145/TAMARIS ) , 525 patients with critical limb ischaemia unsuitable for revascularisation were enrolled from 171 sites in 30 countries . All had ischaemic ulcer in legs or minor skin gangrene and met haemodynamic criteria ( ankle pressure < 70 mm Hg or a toe pressure < 50 mm Hg , or both , or a transcutaneous oxygen pressure < 30 mm Hg on the treated leg ) . Patients were r and omly assigned to either NV1FGF at 0·2 mg/mL or matching placebo ( visually identical ) in a 1:1 ratio . R and omisation was done with a central interactive voice response system by block size 4 and was stratified by diabetes status and country . Investigators , patients , and study teams were masked to treatment . Patients received eight intramuscular injections of their assigned treatment in the index leg on days 1 , 15 , 29 , and 43 . The primary endpoint was time to major amputation or death at 1 year analysed by intention to treat with a log-rank test using a multivariate Cox proportional hazard model . This trial is registered with Clinical Trials.gov , number NCT00566657 . FINDINGS 259 patients were assigned to NV1FGF and 266 to placebo . All 525 patients were analysed . The mean age was 70 years ( range 50 - 92 ) , 365 ( 70 % ) were men , 280 ( 53 % ) had diabetes , and 248 ( 47 % ) had a history of coronary artery disease . The primary endpoint or components of the primary did not differ between treatment groups , with major amputation or Output:

None of the nonrevascularization-based treatments were associated with a significant effect on mortality . Very low- quality evidence , mainly due to imprecision and increased risk of bias , suggests that intermittent pneumatic compression and spinal cord stimulators may reduce the risk of amputations .

MS2_1shot428

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND Formal family meetings have been recommended as a useful approach to assist in goal setting , facilitate decision making , and reduce use of ineffective re sources in the ICU . We examined patient outcomes before and after implementation of an intensive communication system ( ICS ) to test the effect of regular , structured formal family meetings on patient outcomes among long-stay ICU patients . METHODS One hundred thirty-five patients receiving usual care and communication were enrolled as the control group , followed by enrollment of intervention patients ( n = 346 ) , from five ICUs . The ICS included a family meeting within 5 days of ICU admission and weekly thereafter . Each meeting discussed medical up date , values and preferences , and goals of care ; treatment plan ; and milestones for judging effectiveness of treatment . RESULTS Using multivariate analysis , there were no significant differences between control and intervention patients in length of stay ( LOS ) , the primary end point . Similarly , there were no significant differences in indicators of aggressiveness of care or treatment limitation decisions ( ICU mortality , LOS , duration of ventilation , treatment limitation orders , or use of tracheostomy or percutaneous gastrostomy ) . Exploratory analysis suggested that in the medical ICUs , the intervention was associated with a lower prevalence of tracheostomy among patients who died or had do-not-attempt-resuscitation orders in place . CONCLUSIONS The negative findings of the main analysis , in combination with preliminary evidence of differences among types of unit , suggest that further examination of the influence of patient , family , and unit characteristics on the effects of a system of regular family meetings may be warranted . Despite the lack of influence on patient outcomes , structured family meetings may be an effective approach to meeting information and support needs . TRIAL REGISTRY Clinical Trials.gov ; No. : NCT01057238 ; URL : www . clinical trials.gov BACKGROUND Ten percent to 20 % of trauma patients admitted to the intensive care unit ( ICU ) will die from their injuries . Providing appropriate end-of-life care in this setting is difficult and often late in the patients ' course . Patients are young , prognosis uncertain , and conflict common around goals of care . We hypothesized that early , structured communication in the trauma ICU would improve end-of-life care practice . METHODS Prospect i ve , observational , prepost study on consecutive trauma patients admitted to the ICU before and after a structured palliative care intervention was integrated into st and ard ICU care . The program included part I , early ( at admission ) family bereavement support , assessment of prognosis , and patient preferences , and part II ( within 72 hours ) interdisciplinary family meeting . Data on goals of care discussion s , do-not-resuscitate ( DNR ) orders and withdrawal of life support ( W/D ) were collected from physician rounds , family meetings , and medical records . RESULTS Eighty-three percent of patients received part I and 69 % part II intervention . Discussion of goals of care by physicians on rounds increased from 4 % to 36 % of patient-days . During intervention , rates of mortality ( 14 % ) , DNR ( 43 % ) , and W/D ( 24 % ) were unchanged , but DNR orders and W/D were instituted earlier in hospital course . ICU length of stay was decreased in patients who died . CONCLUSIONS Structured communication between physician and families result ed in earlier consensus around goals of care for dying trauma patients . Integration of early palliative care alongside aggressive trauma care can be accomplished without change in mortality and has the ability to change the culture of care in the trauma ICU STUDY OBJECTIVES To assess the impact of a proactive case finding approach to end-of-life care for critically ill patients experiencing global cerebral ischemia ( GCI ) after cardiopulmonary resuscitation and multiple organ system failure ( MOSF ) in comparison to historical control subjects . DESIGN Comparative study of retrospective and prospect i ve cohorts . SETTING Medical ICU of a university hospital . INTERVENTIONS Patterns of end-of life care for patients with MOSF and GCI obtained through a retrospective chart review were compared to proactive case finding facilitated by the inpatient palliative care service . Interventions included identification of patient 's advance directives or preferences about end-of life care , if any ; assistance with discussion of the prognosis and treatment options with patients or their surrogates ; and implementation of palliative care strategies when treatment goals changed to a focus on comfort measures . RESULTS Although our retrospective data demonstrated a high percentage of do-not-resuscitate decisions for the patients under investigation , a considerable time lag elapsed between identification of the poor prognosis and the establishment of end-of-life treatment goals ( 4.7 + /- 2.4 days and 3.5 + /- 0.5 days for patients with MOSF and GCI , respectively [ mean + /- SE ] ) . The proactive case finding approach decreased hospital length of stay ( mean , 20.6 + /- 4.1 days vs 15.1 + /- 2.5 days and 8.6 + /- 1.6 days vs 4.7 + /- 0.6 days for MOSF and GCI patients , respectively ; p = 0.063 and < 0.001 , respectively ) . More importantly , a proactive palliative care intervention decreased the time between identification of the poor prognosis and the establishment of comfort care goals ( 7.3 + /- 2.9 days vs 2.2 + /- 0.8 days and 6.3 + /- 1.2 days vs 3.5 + /- 0.4 days for MOSF and GCI patients , respectively ; p < 0.05 for both ) , decreased the time dying patients with MOSF remained in the ICU , and reduced the use of nonbeneficial re sources , thus reducing the cost of care . CONCLUSIONS Proactive interventions from a palliative care consultant within this subset of patients decreased the use of nonbeneficial re sources and avoided protracted dying Objective : To determine if a video depicting cardiopulmonary resuscitation and resuscitation preference options would improve knowledge and decision making among patients and surrogates in the ICU . Design : R and omized , unblinded trial . Setting : Single medical ICU . Patients : Patients and surrogate decision makers in the ICU . Interventions : The usual care group received a st and ard pamphlet about cardiopulmonary resuscitation and cardiopulmonary resuscitation preference options plus routine code status discussion s with clinicians . The video group received usual care plus an 8-minute video that depicted cardiopulmonary resuscitation , showed a simulated hospital code , and explained resuscitation preference options . Measurements and Main Results : One hundred three patients and surrogates were r and omized to usual care . One hundred five patients and surrogates were r and omized to video plus usual care . Median total knowledge scores ( 0–15 points possible for correct answers ) in the video group were 13 compared with 10 in the usual care group , p value of less than 0.0001 . Video group participants had higher rates of underst and ing the purpose of cardiopulmonary resuscitation and resuscitation options and terminology and could correctly name components of cardiopulmonary resuscitation . No statistically significant differences in documented resuscitation preferences following the interventions were found between the two groups , although the trial was underpowered to detect such differences . A majority of participants felt that the video was helpful in cardiopulmonary resuscitation decision making ( 98 % ) and would recommend the video to others ( 99 % ) . Conclusions : A video depicting cardiopulmonary resuscitation and explaining resuscitation preference options was associated with improved knowledge of in-hospital cardiopulmonary resuscitation options and cardiopulmonary resuscitation terminology among patients and surrogate decision makers in the ICU , compared with receiving a pamphlet on cardiopulmonary resuscitation . Patients and surrogates found the video helpful in decision making and would recommend the video to others PURPOSE We sought to determine the effects of a communication process that was design ed to encourage the use of advanced supportive technology when it is of benefit , but to limit its burdens when it is ineffective . We compared usual care with a proactive , multidisciplinary method of communicating that prospect ively identified for patients and families the criteria that would determine whether a care plan was effective at meeting the goals of the patient . This process allowed caregivers to be informed of patient preferences about continued advanced supportive technology when its continuation would result in a compromised functional outcome or death . MATERIAL S AND METHODS We performed a before- and -after study in 530 adult medical patients who were consecutively admitted to a university tertiary care hospital for intensive care . Multidisciplinary meetings were held within 72 hours of critical care admission . Patients , families , and the critical care team discussed the care plan and the patients ' goals and expectations for the outcome of critical care . Clinical " milestones " indicative of recovery were identified with time frames for their occurrence . Follow-up meetings were held to discuss palliative care options when continued advanced supportive technology was not achieving the patient 's goals . We measured length of stay , mortality , and provider team and family consensus in 134 patients before the intensive communication intervention and in 396 patients after the intervention . RESULTS Intensive communication significantly reduced the median length of stay from 4 days ( interquartile range , 2 to 11 days ) to 3 days ( 2 to 6 days , P = 0.01 by survival analysis ) . This reduction remained significant after adjustment for acute physiology and chronic health evaluation ( APACHE ) 3 score [ risk ratio ( RR ) = 0.81 ; 95 % confidence interval ( CI ) , 0.66 to 0.99 ; P = 0.04 ) . Subgroup analysis revealed that this reduction occurred in our target group , patients with acuity scores in the highest quartile who died ( RR = 0.60 ; 95 % CI , 0.38 to 0.92 ; P = 0.02 ) . The intervention , which allowed dying patients earlier access to palliative care , was not associated with increased mortality . CONCLUSIONS Intensive communication was associated with a reduction in critical care use by patients who died . Our multidisciplinary process targeted advanced supportive technology to patients who survived and allowed the earlier withdrawal of advanced supportive technology when it was ineffective Comprehension and satisfaction are relevant criteria for evaluating the effectiveness of information provided to family members of intensive care unit ( ICU ) patients . We performed a prospect i ve r and omized trial in 34 French ICUs to compare comprehension of diagnosis , prognosis , treatment , and satisfaction with information provided by ICU caregivers , in ICU patient family representatives who did ( n = 87 ) or did not ( n = 88 ) receive a family information leaflet ( FIL ) in addition to st and ard information . An FIL design ed specifically for this study was delivered at the first visit of the family representative : it provided general information on the ICU and hospital , the name of the ICU physician caring for the patient , a diagram of a typical ICU room with the names of all the devices , and a glossary of 12 terms commonly used in ICUs . Characteristics of the ICUs , patients , and family representatives were similar in the two groups . The FIL reduced the proportion of family members with poor comprehension from 40.9 % to 11.5 % ( p < 0.0001 ) . In the representatives with good comprehension , the FIL was associated with significantly better satisfaction ( 21 [ 18 to 24 , quartiles ] versus 27 [ 24 to 29 , quartiles ] , p = 0.01 ) . These results indicate that ICU caregivers should consider using an FIL to improve the effectiveness of the information they impart to families Objective To develop , deploy , and evaluate an intervention design ed to identify and mitigate conflict in decision making in the intensive care unit . Design Nonr and omized , controlled trial . Setting Seven intensive care units at four Boston teaching hospitals . Patients A total of 1,752 critically ill patients , including 873 study cases analyzed here . InterventionS ocial workers interviewed families of patients deemed at high risk for decisional conflict and provided feedback to the clinical team , who then implemented measures to address the problems identified . Measurements and Main Results Patient or surrogate satisfaction with intensive care unit care and the probability of choosing a specific plan for treatment in the intensive care unit was studied . Inclusion criteria identified 873 patients at risk for decisional conflict . Thirty-nine percent of the patients in the intervention phase of the study ( 172 patients ) received the intervention . In multivariate analyses , receiving the intervention significantly increased the likelihood of deciding to forgo resuscitation ( odds ratio [ OR ] = 1.81 , p = .017 ) , the likelihood of choosing a treatment plan for comfort-care only ( OR = 1.94 , p = .018 ) , and the likelihood of choosing an aggressive-care treatment plan ( OR = 2.30 , p = .002 ) . Receiving the intervention did not significantly affect overall satisfaction with the care provided ( OR = 0.68 , p = .14 ) , satisfaction with the amount of information provided ( OR = 0.86 , p = .44 ) , or satisfaction with the degree of involvement in decision making ( OR = 0.84 , p = .54 ) . Conclusions Although there was no impact on patient or surrogate satisfaction with care provided in the intensive care unit , the intervention did facilitate deliberative decision making in cases deemed at high risk for conflict . The lessons learned from the experience with this intervention should be helpful in ongoing efforts to improve care and to achieve outcomes desired by critically ill patients , their families , and critical care clinicians In this article two new methods for building and evaluating eHealth interventions are described . The first is the Multiphase Optimization Strategy ( MOST ) . It consists of a screening phase , in which intervention components are efficiently identified for inclusion in an intervention or for rejection , based on their performance ; a refining phase , in which the selected components are fine tuned and issues such as optimal levels of each component are investigated ; and a confirming phase , in which the optimized intervention , consisting of the selected components delivered at optimal levels , is evaluated Output:

Few studies demonstrated significant improvements in the primary outcomes . In conclusion , there is limited evidence on the effectiveness of end-of-life decision support for critically ill patients and their surrogate decision makers .

MS2_1shot429

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Some serrated polyps of the colorectum are likely preinvasive lesions , evolving through a newly recognized serrated pathway to colorectal cancer . To assess possible risk and protective factors for serrated polyps and particularly to explore differences in risk factors between polyps in the right and left colorectum , we pooled data from three large multicenter chemoprevention trials . A serrated polyp was defined broadly as any serrated lesion ( hyperplastic , sessile serrated adenoma , “ traditional ” serrated adenoma , mixed adenoma ) diagnosed during each trial 's main treatment period of ∼3 to 4 years . Using generalized linear regression , we computed risk ratios and 95 % confidence intervals as measures of the association between risk for serrated polyps and demographic , lifestyle , and dietary variables . Of the 2,830 subjects that completed at least one follow-up exam after r and omization , 675 ( 23.9 % ) had at least one left-sided serrated polyp and 261 ( 9.2 % ) had at least one right-sided lesion . In the left colorectum , obesity , cigarette smoking , dietary fat , total energy intake , and red meat intake were associated with an increased risk for serrated polyps . In the right colon , aspirin treatment was associated with a reduced risk and family history of polyps and folate treatment were associated with an increased risk for serrated polyps . Our results suggest that several common lifestyle and dietary variables are associated with risk for serrated polyps , and some of these may differ for the right and left colorectum . ( Cancer Epidemiol Biomarkers Prev 2009;18(8):2310–7 OBJECTIVE : The aim of this study was to determine the relationship between fat , fiber , and meat intake , and risk of colorectal adenoma recurrence . METHODS : We determined adenoma recurrence and dietary intake for 1,520 participants in two r and omized trials : The Antioxidant Polyp Prevention Study and Calcium Polyp Prevention Study . Subjects underwent baseline colonoscopy with removal of all adenomas , and dietary intake was estimated with a vali date d semiquantitative food frequency question naire . Follow-up colonoscopy was performed 1 and 4 yr later . Pooled risk ratios for adenoma recurrence were obtained by generalized linear regression , with adjustment for age , sex , clinical center , treatment category , study , and duration of observation . RESULTS : In the total colorectum , fiber intake was weakly and nonsignificantly associated with a risk for all adenomas ( RR quartile 4 vs quartile 1 = 0.85 , 95 % CI 0.69–1.05 ) and advanced adenomas ( RR = 0.88 , 95 % CI 0.54–1.44 ) . Associations were stronger for adenomas in the proximal colon ( RR = 0.73 , 95 % CI 0.56–0.97 ) and some fiber subtypes ( fruit and vegetable , grain ) . There was no association between fat or total red meat intake and risk of adenoma or advanced adenoma recurrence . However , when considering other meats , risk ( quartile 4 vs quartile 1 ) for advanced adenoma was increased for processed meat ( RR = 1.75 , 95 % CI 1.02–2.99 ) and decreased for chicken ( RR = 0.61 , 95 % CI 0.38–0.98 ) . CONCLUSION : The inverse associations between fiber intake and risk of adenoma recurrence we observed are weak , and not statistically significant . Our data indicate that intake of specific meats may have different effects on risk Many N-nitroso compounds ( NOC ) are carcinogens . In this controlled study of 21 healthy male volunteers , levels of NOC on a high ( 420 grams ) red meat diet were significantly greater ( P = 0.001 ) than on a low ( 60 grams ) meat diet but not significantly greater when an equivalent amount of vegetable protein was fed . An 8-mg supplement of haem iron also increased fecal NOC ( P = 0.006 ) compared with the low meat diet , but 35-mg ferrous iron had no effect . Endogenous N-nitrosation , arising from ingestion of haem but not inorganic iron or protein , may account for the increased risk associated with red meat consumption in colorectal cancer Cooking meats at high temperatures and for long duration produces heterocyclic amines and other mutagens . These meat-derived mutagenic compounds have been hypothesized to increase risk of colorectal neoplasia , but prospect i ve data are unavailable . We examined the association between intakes of the heterocyclic amines 2-amino-3,8-dimethylimidazo[4,5,-f]quinoxaline ( MeIQx ) , 2-amino-1-methyl-6-phenylimidazo[4,5-b]pyridine ( PhIP ) , 2-amino-3,4,8-trimethylimidazo[4,5,-f]quinoxaline ( DiMeIQx ) , and meat-derived mutagenicity ( MDM ) and risk of distal colon adenoma using a cooking method question naire administered in 1996 in the Health Professionals Follow-up Study cohort . Between 1996 and 2002 , 581 distal colon adenoma cases were identified . Higher intake of MDM was marginally associated with increased risk of distal adenoma [ fourth versus lowest quintile : odds ratio ( OR ) , 1.39 ; 95 % confidence interval ( 95 % CI ) , 1.05 - 1.84 ; highest versus lowest quintile : OR , 1.29 ; 95 % CI , 0.97 - 1.72 ; Ptrend = 0.08 ] . Adjusting for total red meat or processed meat intake did not explain those associations . Our data also suggested a positive association between higher MeIQx ( highest versus lowest quintile : OR , 1.28 ; 95 % CI , 0.95 - 1.71 ; Ptrend = 0.22 ) and risk of adenoma , but this association was attenuated after adjusting for processed meat intake . DiMeIQx and PhIP did not seem to be associated with risk of adenoma . In conclusion , higher consumption of mutagens from meats cooked at higher temperature and longer duration may be associated with higher risk of distal colon adenoma independent of overall meat intake . Because mutagens other than heterocyclic amines also contribute to MDM , our results suggest that mutagens other than heterocyclic amines in cooked meats may also play a role in increasing the risk of distal adenoma . ( Cancer Epidemiol Biomarkers Prev 2006;15(6):1120–5 Diet has long been thought to be an important factor in the etiology of colorectal cancer . The specific dietary nutrients or factors responsible for this disease , the second leading cause of cancer death in the United States [ 1 ] , have not , however , been clearly eluci date d. Colorectal adenomatous polyps ( here referred to as polyps ) are generally considered to be precursor lesions for most cases of colorectal carcinoma [ 2 - 4 ] ; however , little is known about their risk factors . Since the introduction of fiberoptic endoscopy , especially colonoscopy , attention has focused on the potential for preventing colorectal cancer by screening for and resecting the adenomas [ 5 , 6 ] . Because of their high recurrence rate after resection [ 7 , 8 ] , these polyps have been used as an end point for the study of potential chemopreventive agents . Four studies have explored potential dietary risk factors for incident colorectal adenomatous polyps [ 9 - 12 ] . No previous observational studies have explored the role of diet or other lifestyle factors in the recurrence of polyps after polypectomy . We discuss the results of a casecontrol study of colorectal polyps among patients from three colonoscopy practice s and analyze dietary risk factors for both incident and recurrent polyps . Methods Our study sample included patients having colonoscopy at three colonoscopy practice s in New York City between April 1986 and March 1988 . In total , 2988 patients were evaluated . Of these , 2443 ( 81.8 % ) were eligible for our study ( patients had to be between 35 and 84 years of age ; reside in New York , New Jersey , or Connecticut ; speak English or Spanish ; and have colonoscopy to at least the splenic flexure ) . The colonoscopists completed data sheets indicating the reason for colonoscopy and the clinical findings at the time of colonoscopy . The study pathologist review ed slides of all suspected neoplastic lesions . All eligible participants received a letter signed by their colonoscopist introducing the study . A trained interviewer then contacted and interviewed participants by telephone . Alternatively , the question naire was mailed for self-completion and was followed by a telephone interview to resolve any remaining questions . An earlier study indicated that the results obtained for dietary factors were similar for both interview methods [ 13 ] . The interview itself consisted of a general question naire that focused on demographic characteristics , medical history , lifestyle , family history , and other topics . The dietary interview consisted of the Block food frequency question naire and specified food intake for a period 3 to 5 years before the colonoscopy [ 14 ] . Ultimately , 1956 dietary question naires were completed ( 80.1 % of eligible patients ) . Of these , 71 % were conducted by telephone , and 29 % were returned by mail . An incident case of adenomatous polyps was defined as an eligible participant with no history of colon carcinoma , adenomatous polyps , or inflammatory bowel disease who was found to have one or more pathologically defined polyps on the index colonoscopy . The incident control group consisted of persons who were found to be free of colorectal neoplasia on index colonoscopy and who were without a history of adenomatous polyps , colon cancer , or inflammatory bowel disease . A case of recurrent polyps was defined as an eligible participant with a self-reported history of one or more polyps who had a pathologically confirmed polyp on the index colonoscopy . The recurrent control was defined as a participant whose index colonoscopy showed no colorectal neoplasia but who had a history of one or more polyps . Cases and controls with a history of colorectal cancer or inflammatory bowel disease were excluded . Although we did not have pathologic confirmation of all initial polyps , we did obtain pathology reports on a r and om sample of 100 recurrent cases and controls and found 97 to be adenomatous . By these criteria , 286 incident cases ( 162 men and 124 women ) and 480 incident controls ( 210 men and 270 women ) were identified , whereas 186 recurrence cases ( 130 men and 56 women ) and 330 recurrence controls ( 187 men and 143 women ) were found . Food item and nutrient data were generated by software programs provided by Block and coworkers [ 14 ] at the National Cancer Institute . The main analyses were done using logistic regression modelling and maximum likelihood ratios [ 15 ] in the BMDP-LR program . Analyses were conducted separately for men and women . Age , Quetelet index , and caloric intake were entered as covariates for most analyses . A previous study by our group had shown obesity , as measured by Quetelet index , to be a risk factor for polyps among women ; the trend for men was not significant [ 16 ] . Analyses in which nutrients were st and ardized per 1000 kilocalories were also done for comparison [ 17 ] . For each nutrient or food group , quartiles were defined by review of the control group data ; the lowest quartile was given a reference value of 1.0 , and odds ratios were calculated for each of the other quartiles , with 95 % confidence intervals ( CIs ) for the highest-to-lowest quartile comparison . The probability of a linear trend was calculated by entering the four quartiles as ordered categories . Results The case and control groups for the incidence and recurrence studies were generally similar in age distribution and education . Table 1 shows a comparison of the characteristics of the case and control groups for both the incident and recurrent groups . Most polyps were 5 mm or larger in size and had at least some degree of atypia . The site distribution of the incident polyps showed a preponderance to the left . Most incident case and control participants had colonoscopy because of overt or occult rectal bleeding . A larger proportion of the recurrent polyps were right-sided ( P = 0.005 ) . The time interval from initial polypectomy to index colonoscopy was 4.3 years for cases and 3.7 years for controls ( P > 0.2 ) . Table 1 . Polyp Characteristics for Incident and Recurrent Cases Tables 2 and 3 show the odds ratios by quartile , using the lowest quartile as the referent group , for some of the 15 nutrients and food groups evaluated . The results for vegetables , red meat , beef , cheese , protein , vitamin C , and carotene are not shown ; however , no consistent differences were found . Table 2 . Odds Ratios of Incident Polyps by Quartile of Selected Nutrients and Food Groups , Adjusted for Age , Quetelet Index , and Caloric Intake Table 3 . Odds Ratios of Recurrent Polyps by Quartile of Selected Nutrients and Food Groups , Adjusted for Age , Quetelet Index , and Caloric Intake Men The only dietary risk factor statistically associated with the risk for colorectal adenomatous polyps in men was caloric intake ; however , this association Output:

There was evidence of a nonlinear association between red meat ( pnonlinearity < 0.001 ) and processed meat ( pnonlinearity = 0.01 ) intake and colorectal adenoma risk .

MS2_1shot430

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Abstract This double-blind , sham-controlled study sought to investigate the effectiveness of cranial electrotherapy stimulation ( CES ) for the treatment of bipolar II depression ( BD II ) . After r and omization , the active group participants ( n = 7 ) received 2 mA CES treatment for 20 minutes five days a week for 2 weeks , whereas the sham group ( n = 9 ) had the CES device turned on and off . Symptom non-remitters from both groups received an additional 2 weeks of open-label active treatment . Active CES treatment but not sham treatment was associated with a significant decrease in the Beck Depression Inventory ( BDI ) scores from baseline to the second week ( p = 0.003 ) maintaining significance until week 4 ( p = 0.002 ) . There was no difference between the groups in side effects frequency . The results of this small study indicate that CES may be a safe and effective treatment for BD II suggesting that further studies on safety and efficacy of CES may be warranted OBJECTIVES This pilot study examined the potential efficacy of cranial electric stimulation for the treatment of insomnia . DESIGN The research ers tested the hypothesis through a r and omized , double-blind , and placebo controlled clinical trial . The research ers approached eligible subjects who scored 21 or above on the Pittsburgh Insomnia Rating Scale . The research ers then r and omly assigned the subjects to receive either an active or sham device . Each study subject received 60min of active or sham treatment for five days . Following each intervention the subjects completed a sleep log , as well as three and ten days later . SETTING The research ers conducted the study among active duty service members receiving mental health care on the Psychiatry Continuity Service ( PCS ) , Walter Reed National Military Medical Center in Bethesda , MD . MAIN OUTCOME MEASURES The study 's primary outcome variables were the time to sleep onset , total time slept , and number of awakenings as reported by the subjects in the serial sleep logs . The research ers identified a nearly significant increase in total time slept after three cranial electric stimulation treatments among all study subjects . A closer examination of this group revealed an interesting gender bias , with men reporting a robust increase in total time slept after one treatment , decay in effect over the next two interventions , and then an increase in total time slept after the fourth treatment . The research ers speculate that the up and down effect on total time slept could be the result of an insufficient dose of cranial electric stimulation Results of a r and omized , double-blind pilot study indicate that transcranial electrotherapy stimulation may be an effective treatment for the temporary reduction of pain in osteoarthritis patients . Presently , the predominant method for pain management is medication . One very different approach is the application of micro- to milliamp current applied to specific areas of the head , result ing in a release of endogenous opioids from pain management regions of the brain . For the pilot study , 64 subjects suffering from osteoarthritis of the knee and /or hip were enrolled . For two weeks prior , then during and after treatment , subject pain was self-assessed using the visual scale ( VS ) . In addition , subjects were globally assessed by a physician . All subjects , device operators and physicians were blinded as to whether subjects were treated with an active or sham device . Data collected from the study indicate both a decrease in VS pain scores and a significant improvement ( p = 0.05 ) in physician assessment in subjects treated with active devices compared to those treated with the sham device To investigate the effects of microcurrent cranial electrical stimulation ( CES ) therapy on reducing pain and its associated symptoms in fibromyalgia ( FM ) , we conducted a r and omized , controlled , three-group ( active CES device , sham device , and usual care alone [ UC ] ) , double-blind study to determine the potential benefit of CES therapy for symptom management in FM . Those individuals using the active CES device had a greater decrease in average pain ( p = .023 ) , fatigue ( p = .071 ) , and sleep disturbance ( p = .001 ) than individuals using the sham device or those receiving usual care alone over time . Additionally , individuals using the active CES device had improved functional status versus the sham device and UC groups over time ( p = .028 ) Abstract Background Chronic pain is a significant problem for many individuals following spinal cord injury ( SCI ) . Unfortunately , SCI-related neuropathic pain has proven to be largely refractory to analgesic medications and other available treatments . Cranial electrotherapy stimulation ( CES ) has been effective in managing some types of pain . It involves the application of a small amount of current through the head via ear clip electrodes . Objective Explore the effectiveness of CES for neuropathic pain in persons with SCI and chronic pain . Study design Multi-site , double-blind , sham-controlled study . Participants Adults with SCI and chronic neuropathic pain at or below the level of injury were r and omized to receive active or sham CES . Intervention Application of active CES or sham CES 1 hour daily for 21 days . Six-month open-label phase to assess ‘ as-needed ’ CES use . Outcome measures Change in pre- to post-session pain ratings as well as change in pain intensity , pain interference , pain quality , pain beliefs and coping strategies , general physical and mental health status , depressive symptomatology , perceived stress , and anxiety pre- to post-treatment . Results The active group reported a significantly greater average decrease in pain during daily treatments than the sham group ( Kruskal – Wallis chi-square = 4.70 , P < 0.05 ) . During the 21-day trial , there was a significant group × time interaction for only one outcome variable ; the active group showed larger pre- to post-treatment decreases in pain interference than the sham group did ( F = 8.50 , P < 0.01 , d = 0.59 ) . Conclusions On average , CES appears to have provided a small but statistically significant improvement in pain intensity and pain interference with few troublesome side effects . Individual results varied from no pain relief to a great deal of relief Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVE To examine the efficacy of transcranial electrical stimulation a non-invasive method of reducing pain . DESIGN A r and omized , double-blind , placebo-controlled trial . SUBJECTS A total of 119 patients with chronic pain . METHODS Patients were treated with either transcranial electrical stimulation or an active placebo device . Short- and long-term follow-ups were evaluated for treatment efficacy with 4 ordinal scale variables : visual analogue scale ( pain level ) , SLEEP ( how often does pain disturb sleep ) , FREQ ( frequency of pain ) and MED ( frequency of use of medications to relieve pain ) . RESULTS Pain level decreased significantly in the transcranial electrical stimulation-treated group compared with the active-placebo group 3 weeks after the end of treatment ( p = 0.0017 between groups ) . Other parameters did not demonstrate significant differences . Three months after the end of treatment this effect was maintained and other treatment parameters showed similar improvements . CONCLUSION Transcranial electrical stimulation is an effective non-invasive method for pain relief . The active placebo device has a powerful effect on reported pain , which diminishes in the long-term . The involvement of possible neural mechanisms is discussed Objectives . To assess the feasibility of treating musculoskeletal pain in the lower back and /or lower extremities in persons with Parkinson 's disease ( PD ) with cranial electrotherapy stimulation ( CES ) . Design . R and omized , controlled , double-blind trial . Setting . Veterans Affairs Medical Center , Community . Participants . Nineteen persons with PD and pain in the lower back and /or lower extremities . Thirteen provided daily pain rating data . Intervention . Of the thirteen participants who provided daily pain data , 6 were r and omly provided with active CES devices and 7 with sham devices to use at home 40 minutes per day for six weeks . They recorded their pain ratings on a 0-to-10 scale immediately before and after each session . Main Outcome Measure . Average daily change in pain intensity . Results . Persons receiving active CES had , on average , a 1.14-point decrease in pain compared with a 0.23-point decrease for those receiving sham CES ( Wilcoxon Z = −2.20 , P = .028 ) . Conclusion . Use of CES at home by persons with PD is feasible and may be somewhat helpful in decreasing pain . A larger study is needed to determine the characteristics of persons who may experience meaningful pain reduction with CES . Guidelines for future studies are provided Treatments for chronic pain in persons with spinal cord injury ( SCI ) have been less than effective . Cranial electrotherapy stimulation ( CES ) , a noninvasive technique that delivers a microcurrent to the brain via ear clip electrodes , has been shown to effectively treat several neurological and psychiatric disorders . The present study examined the effects of daily 1-hour active CES or sham CES treatment ( r and omly assigned ) for 21 days on pain intensity and interference with activities in 38 males with SCI . The active CES group ( n = 18 ) reported significantly decreased daily pain intensity compared with the sham CES group ( n = 20 ) ( mean change : active CES = -0.73 , sham CES = -0.08 ; p = 0.03 ) . Additionally , the active CES group reported significantly decreased pain interference ( -14.6 pre- vs postintervention , p = 0.004 ) in contrast to the nonsignificant decrease in the sham CES group ( -4.7 pre- vs postintervention , p = 0.24 ) . These results suggest that CES can effectively treat chronic pain in persons with SCI OBJECTIVE To investigate the effects of microcurrent cranial electrical stimulation ( CES ) therapy on activity in pain processing brain regions . DESIGN A r and omized , controlled , three-group , double-blind pilot study . PARTICIPANTS Persons with physician-diagnosed fibromyalgia . INTERVENTION Active CES device , sham device , and usual care alone . RESULTS Those individuals using the active device had a greater decrease in average pain ( P = .023 ) than individuals using the sham device or receiving usual care alone over time . Preliminary analyses of the functional magnetic resonance imaging data on a subset of six participants from each of the two device groups show that individuals using an active CES device had a decrease in activation in the pain processing regions of the brain compared to those using a sham device . CONCLUSIONS The observed decrease in activation in the pain processing regions may indicate a decrease in neural activity in these regions that may be related to decreased pain . This is the first r and omized , controlled trial of CES in patients diagnosed with fibromyalgia to report functional magnetic resonance imaging data We examined efficacy and safety of one specific cranial electrical stimulator ( CES ) device at a fixed setting in subjects with treatment-resistant major depressive disorder ( MDD ) . Thirty subjects ( 57 % female , mean age 48.1 ± 12.3 years ) with MDD and inadequate response to st and ard antidepressants were r and omized to 3 weeks of treatment with CES ( 15/500/15,000 Hz , symmetrical rectangular biphasic current of 1 - 4 mAmp , 40 V ) or sham CES ( device off ) for 20 min , 5 days per week . The primary outcome measure was improvement in the 17-item Hamilton Depression Rating Scale ( HAM-D-17 ) . Adverse effects ( AEs ) were assessed using the Patient Related Inventory of Side Effects ( PRISE ) . Completion rates were 88 % for CES , 100 % for sham . Both treatment groups demonstrated improvement of about 3 - 5 points in HAM-D-17 scores ( p < 0.05 for both ) , and no significant differences were observed between groups . Remission rates were 12 % for CES , and 15 % for sham , a nonsignificant difference . CES was deemed safe , with good tolerability ; poor concentration and malaise were the only distressing AEs that differed significantly between CES and sham ( p = 0.019 and p = 0.043 , respectively ) . Limitations include a small sample and lack of an active comparator therapy . Although both treatment groups improved significantly , this CES at the setting chosen did not separate from sham in this sample . Thus we can not rule out that the benefit from this setting used in this particular form of CES was due to placebo effects . Since this form of CES has other setting s , future studies should test these setting s and compare it against other CES devices . Clinical trials.gov ID : NCT01325532 Since the late 1940s investigators in Russia and Europe have reported that electrosleep therapy is effective for the full spectrum of psychiatric disorders and many “ psychophysiological ” disorders , such as acid-peptic disease , essential hypertension , neurodermatitis etc . Few of these studies are controlled , and to date there is a paucity of double blind , controlled inquiries to aid the clinician in objective evaluation of the indications , contraindications , efficacy , and mode of application for this somatic therapy . A recent controlled study indicates that electrosleep therapy is effective for patients with prominent symptoms of anxiety , insomnia and depression . Our study was design ed to test on a double blind , controlled basis the efficacy of electrosleep therapy on patients with chronic ( more than 2 years ) psychiatric illness unresponsive to current treatment modalities in which the prominent symptoms were anxiety , insomnia , and depression with no evidence of medical illness that could account for these symptoms . All patients received a comprehensive , systematic , diagnostic research interview with diagnoses based on criteria for scoring symptoms positive ( Appendix 1 ) and criteria for each psychiatric syndrome involved ( Appendix 2 ) . Patients were r and omly assigned to one of two groups . Group I patients received 10 active electrosleep treatments Output:

Pooled effects for anxiety were statistically significant , favoring active treatment . The analysis found no benefit for insomnia or brain dysfunction and a small beneficial effect for headache .

MS2_1shot431

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Background One of the rationale s behind using strength training in the treatment of adolescents with Patellofemoral Pain ( PFP ) is that reduced strength of the lower extremity is a risk factor for PFP and a common deficit . This rationale is based on research conducted on adolescents > 15 years of age but has never been investigated among young adolescents with PFP . Objectives To compare isometric muscle strength of the lower extremity among adolescents with PFP compared to age- and gender-matched pain-free adolescents . Methods In 2011 a population -based cohort ( APA2011-cohort ) consisting of 768 adolescents aged 12–15 years from 8 local schools was formed . In September 2012 , all adolescents who reported knee pain in September 2011 were offered a clinical examination if they still had knee pain . From these , 20 adolescents ( 16 females ) were diagnosed with PFP . Pain-free adolescents from the APA2011-cohort ( n = 20 ) were recruited on r and om basis as age- and gender-matched pairs . Primary outcome was isometric knee extension strength normalized to body weight ( % BW ) and blinded towards subject information . Secondary outcomes included knee flexion , hip abduction/adduction and hip internal/external rotation strength . Demographic data included Knee Injury and Osteoarthritis Outcome Score ( KOOS ) and symptom duration . Results Adolescents with PFP reported long symptom duration and significantly worse KOOS scores compared to pain-free adolescents . There were no significant differences in isometric knee extension strength ( Δ0.3 % BW , p = 0.97 ) , isometric knee flexion strength ( Δ0.4 % BW , p = 0.84 ) or different measures of hip strength ( Δ0.4 to 1.1 % BW , p>0.35 ) . Conclusion Young symptomatic adolescents with PFP between 12 and 16 years of age did not have decreased isometric muscle strength of the knee and hip . These results question the rationale of targeting strength deficits in the treatment of adolescents with PFP . However , strength training may still be an effective treatment for those individuals with PFP suffering from strength deficits Objectives Describe proportions of individuals with patellofemoral pain ( PFP ) with an unfavourable recovery over 12 months ; identify clinical predictors of poor recovery at 3 and 12 months ; and determine baseline values of predictors that identify those with poor 12-month prognosis . Methods An observational analysis utilised data from 310 individuals with PFP enrolled in two r and omised clinical trials . Thirteen baseline variables ( participant , PFP , study characteristics ) were investigated for their prognostic ability . Pain , function and global recovery were measured at 3 and 12 months . Multivariate backward stepwise regression analyses ( treatment-adjusted , p<0.10 ) were performed for each follow-up measure . Receiver operator characteristic curves identified cut-points associated with unfavourable recovery at 12 months . Results 55 % and 40 % of participants had an unfavourable recovery at 3 and 12 months , respectively . Longer baseline pain duration was significantly associated with poor 3-month and 12-month recovery on measures of pain severity ( β 11.36 to 24.94 ) , Anterior Knee Pain ( AKP ) Scale ( −4.44 to −11.33 ) and global recovery ( OR : 2.32 to 6.11 ) . Greater baseline pain severity and lower AKP Scale score were significantly associated with poor recovery on multiple measures ( p<0.05 ) . Baseline duration > 2 months and AKP Scale score < 70/100 were associated with unfavourable 12-month recovery . Conclusions A substantial number of individuals with PFP have an unfavourable recovery over 12 months , irrespective of intervention . Knee pain duration > 2 months is the most consistent prognostic indicator , followed by AKP Scale score < 70 . Sports medicine practitioners should utilise interventions with known efficacy in reducing PFP , and promote early intervention to maximise prognosis . Trial registration Australian study : Australian Clinical Trials Registry ( ACTRN012605000463673 ) , Clinical Trials.gov ( NCT00118521 ) ; Dutch study : International St and ard R and omised Controlled Trial Number Register ( IS RCT N83938749 Purpose The purpose of the study was to investigate if changes in psychological variables are related to the outcome in pain and disability in patients with chronic anterior knee pain . Methods A longitudinal observational study on 47 patients with chronic anterior knee pain was performed in a secondary healthcare setting . Pain was measured with the visual analogue scale and disability with the Lysholm scale . The psychological variables , such as anxiety , depression , pain coping strategies , catastrophizing and fear to movement beliefs , were studied by using self-administered question naires . Results Among the pain coping strategies , only the catastrophizing subscale showed a significant reduction . Similarly , anxiety , depression and kinesiophobia were significantly reduced after treatment . Those patients who decreased the catastrophizing , kinesiophobia , anxiety and depression showed a greater improvement in pain and disability after a purely biomedical treatment . A multiple regression analysis revealed that changes in catastrophizing predicted the amount of improvement in pain severity and that changes in both catastrophizing and anxiety predicted changes in disability after treatment . Conclusion What has been found suggests that clinical improvement in pain and disability is associated with a reduction in catastrophizing and kinesiophobia . Therefore , co- interventions to reduce catastrophizing thinking and kinesiophobia may enhance the results .Level of evidence Prospect i ve Cohort Study , Level I for prognosis AIM To study the prevalence of persistent post-surgical pain ( PPSP ) and neuropathic pain ( NP ) after total knee replacement ( TKR ) . METHODS MEDLINE and Embase data bases were search ed for articles published until December 2014 in English language . Published articles were included if they referred to pain that lasts at least 3 mo after primary TKR for knee osteoarthritis , and measured pain with pain specific instruments . Studies that referred to pain caused by septic reasons and implant malalignment were excluded . Both prospect i ve and retrospective studies were included and only 14 studies that match the inclusion criteria were selected for this review . RESULTS The included studies were characterized by the heterogeneity on the scales used to measure pain and pre-operative factors related to PPSP and NP . The reported prevalence of PPSP and NP seems to be relatively high , but it varies among different studies . There is also evidence that the prevalence of post-surgical pain is related to the scale used for pain measurement . The prevalence of PPSP is ranging at 6 mo from 16 % to 39 % and at 12 mo from 13.1 % to 23 % and even 38 % of the patients . The prevalence of NP at 6 mo post-operatively is ranging from 5.2 % to 13 % . Pre-operative factors related to the development of PPSP also differ , including emotional functioning , such as depression and pain catastrophizing , number of comorbidities , pain problems elsewhere and operations in knees with early grade of osteoarthritis . CONCLUSION No firm conclusions can be reached regarding the prevalence of PPSP and NP and the related factors due to the heterogeneity of the studies & NA ; Few studies have investigated whether prognostic indicators , which contribute to the transition from acute to chronic low back pain ( LBP ) , are also those which contribute to continuing persistence of chronic LBP . We compared the contribution of physical , psychological and social indicators to predicting disability after one year between consulters with LBP of less than 3 months duration and more than 3 months duration . Data from two large prospect i ve cohort studies of consecutive patients consulting with LBP in general practice s were merged , providing complete data for 258 cases with acute/subacute LBP and 668 cases with chronic LBP at 12 months follow‐up . There were significant differences between the two LBP groups in baseline characteristics and clinical course of disability , assessed by Rol and Morris Disability Question naire , during the year of follow‐up . Adjusted associations between potential prognostic indicators and disability at 12 months were carried out in the two LBP subgroups . The final multivariable regression models showed that being non‐employed , having widespread pain , a high level of Chronic Pain Grade , and catastrophising were the strongest prognostic indicators for disability at 12 months in both LBP groups . Fear of pain was significantly associated with disability in chronic LBP . Importantly , beyond baseline disability , the effect size of the other prognostic indicators for poor outcome was rather low . These findings must continue to challenge research ers to identify useful early predictors of outcome in persons with disabling back pain , as screening and targeted treatment approaches are dependent upon prognostic indicators with clinical significance & NA ; The objective of this study is to determine whether depression is an independent risk factor for onset of an episode of troublesome neck and low back pain . There is growing evidence that pain problems increase the risk of depression . However , the evidence about the role of depression as a risk factor for onset of pain problems is contradictory . This lack of consistency in research findings may be due in part to method ological weaknesses in existing studies , for example , use of an inappropriate study design and inadequate consideration of confounding . A population ‐based r and om sample of adults was surveyed and followed at 6 and 12 months . Individuals at risk of troublesome ( intense and /or disabling ) neck or low back pain are the subjects of this report ( n=790 ) . We used Cox proportional hazards models to measure the time‐varying effect of depressive symptoms on the onset of troublesome neck and low back pain . Our multivariable analysis considered the possible confounding effects of demographic and socio‐economic factors , health status , co‐morbid medical conditions and injuries to the neck or low back . We found an independent and robust relationship between depressive symptoms and onset of an episode of pain . In comparison with the lowest quartile of scores ( the least depressed ) , those in the highest quartile of depression scores had a four‐fold increased risk of troublesome neck and low back pain ( adjusted HRR 3.97 ; 95 % CI 1.81–8.72 ) . Depression is a strong and independent predictor for the onset of an episode of intense and /or disabling neck and low back pain Purpose This r and omized controlled trial had two main aims . The first aim was to investigate the effect of early preventive , psychologically informed , interventions for pain-related disability . The second aim was explore whether people who are matched to an intervention specifically targeting their psychological risk profile had better outcomes than people who were not matched to interventions . Methods A total of 105 participants were recruited from their workplace , screened for psychological risk factors and classified as being at risk for long-term pain-related disability . They were subgrouped into one of three groups based on their psychological profile . Three behaviorally oriented psychological interventions were developed to target each of the three risk profiles . Half of the participants were assigned a matched intervention developed to target their specific profile , and half were assigned an unmatched intervention . After treatment , repeated measure ANOVAs and χ2 tests were used to determine if treatments had an effect on primary and secondary outcomes including perceived disability , sick leave , fear and avoidance , pain catastrophizing and distress , and if matched participants had better outcomes than did unmatched . Results Treatments had effects on all outcome variables ( effect sizes d ranging between 0.23 and 0.66 ) , but matched participants did not have better outcomes than unmatched . Conclusions Early , preventive interventions have an impact on a number of outcome variables but it is difficult to realize a matching procedure . More in-depth research of the process of matching is needed This study was a prospect i ve single blind r and omised controlled trial to compare the effects of rehabilitation with emphasis on retraining the vastus medialis ( VMO ) component of the quadriceps femoris muscle and rehabilitation with emphasis on general strengthening of the quadriceps femoris muscles on pain , function and Quality of Life in patients with patellofemoral pain syndrome ( PFPS ) . Patients with PFPS ( n=69 ) were recruited from a hospital orthopaedic clinic and r and omised into three groups : ( 1 ) physiotherapy with emphasis on selectively retraining the VMO ( Selective ) ; ( 2 ) physiotherapy with emphasis on general strengthening of the quadriceps femoris muscles ( General ) ; and ( 3 ) a no-treatment control group ( Control ) . The three groups were then compared before and after an eight-week rehabilitation period . The Selective and General groups demonstrated statistically significant and ' moderate ' to ' large ' effect size reductions in pain when compared to the Control group . Both the Selective and General groups displayed statistically significant and ' moderate ' and ' large ' effect size improvements in subjective function and Quality of Life compared to the Control group . Knee flexion excursion during the stance phase of gait , demonstrated that there were no statistical significant differences and only ' trivial ' to ' small ' effect size differences between the Selective or General groups and the Control group . A large number of PFPS patients can experience significant improvements in pain , function and Quality of Life , at least in the short term , with quadriceps femoris rehabilitation , with or without emphasis on selective activation of the VMO component . Both approaches would seem acceptable for rehabilitating patients with PFPS . It may be appropriate to undertake exercises involving selective activation of the vastus medialis early in the rehabilitation process , however , clinicians should not overly focus on selective activation before progressing rehabilitation , especially in more chronic cases Output:

There is limited evidence of mental health and cognitive differences in some individuals with PFP . Features demonstrating linear correlations with pain and physical function included anxiety/depression , catastrophising , praying and hoping and pain-related fear . Conclusions Anxiety , depression , catastrophising and fear of movement may be elevated in individuals with PFP and correlate with pain and reduced physical function .

MS2_1shot432

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: The purpose of this study was to prospect ively compare participant experience and preference of limited preparation computed tomography colonography ( CTC ) with full-preparation colonoscopy in a consecutive series of patients at increased risk of colorectal cancer . CTC preparation comprised 180 ml diatrizoate meglumine , 80 ml barium and 30 mg bisacodyl . For the colonoscopy preparation 4 l of polyethylene glycol solution was used . Participants ’ experience and preference were compared using the Wilcoxon signed rank test and the chi-squared test , respectively . Associations between preference and experience parameters for the 173 participants were determined by logistic regression . Diarrhoea occurred in 94 % of participants during CTC preparation . This side effect was perceived as severely or extremely burdensome by 29 % . Nonetheless , the total burden was significantly lower for the CTC preparation than for colonoscopy ( 9 % rated the CTC preparation as severely or extremely burdensome compared with 59 % for colonoscopy ; p < 0.001 ) . Participants experienced significantly more pain , discomfort and total burden with the colonoscopy procedure than with CTC ( p < 0.001 ) . After 5 weeks , 69 % preferred CTC , 8 % were indifferent and 23 % preferred colonoscopy ( p < 0.001 ) . A burdensome colonoscopy preparation and pain at colonoscopy were associated with CTC preference ( p < 0.04 ) . In conclusion , participants ’ experience and preference were rated in favour of CTC with limited bowel preparation compared with full-preparation colonoscopy CONTEXT Conventional colonoscopy is the best available method for detection of colorectal cancer ; however , it is invasive and not without risk . Computed tomographic colonography ( CTC ) , also known as virtual colonoscopy , has been reported to be reasonably accurate in the diagnosis of colorectal neoplasia in studies performed at expert centers . OBJECTIVE To assess the accuracy of CTC in a large number of participants across multiple centers . DESIGN , SETTING , AND PARTICIPANTS A nonr and omized , evaluator-blinded , noninferiority study design of 615 participants aged 50 years or older who were referred for routine , clinical ly indicated colonoscopy in 9 major hospital centers between April 17 , 2000 , and October 3 , 2001 . The CTC was performed by using multislice scanners immediately before st and ard colonoscopy ; findings at colonoscopy were reported before and after segmental unblinding to the CTC results . MAIN OUTCOME MEASURES The sensitivity and specificity of CTC and conventional colonoscopy in detecting participants with lesions sized at least 6 mm . Secondary outcomes included detection of all lesions , detection of advanced lesions , possible technical confounders , participant preferences , and evidence for increasing accuracy with experience . RESULTS A total of 827 lesions were detected in 308 of 600 participants who underwent both procedures ; 104 participants had lesions sized at least 6 mm . The sensitivity of CTC for detecting participants with 1 or more lesions sized at least 6 mm was 39.0 % ( 95 % confidence interval [ CI ] , 29.6%-48.4 % ) and for lesions sized at least 10 mm , it was 55.0 % ( 95 % CI , 39.9%-70.0 % ) . These results were significantly lower than those for conventional colonoscopy , with sensitivities of 99.0 % ( 95 % CI , 97.1%->99.9 % ) and 100 % , respectively . A total of 496 participants were without any lesion sized at least 6 mm . The specificity of CTC and conventional colonoscopy for detecting participants without any lesion sized at least 6 mm was 90.5 % ( 95 % CI , 87.9%-93.1 % ) and 100 % , respectively , and without lesions sized at least 10 mm , 96.0 % ( 95 % CI , 94.3%-97.6 % ) and 100 % , respectively . Computed tomographic colonography missed 2 of 8 cancers . The accuracy of CTC varied considerably between centers and did not improve as the study progressed . Participants expressed no clear preference for either technique . CONCLUSIONS Computed tomographic colonography by these methods is not yet ready for widespread clinical application . Techniques and training need to be improved PURPOSE To compare reduced colonic cleansing based on dietary fecal tagging ( FT ) with st and ard ( non-FT ) colonic cleansing with regard to patient acceptance , sensitivity , and specificity . MATERIAL S AND METHODS In 50 patients ( FT group ) , FT was performed by means of diet , magnesium citrate , and a barium suspension . In another 50 patients ( non-FT group ) , preparation was based on polyethylene glycol administration . All patients underwent conventional colonoscopy after computed tomographic ( CT ) colonography . Sensitivity and specificity for polyp detection were calculated by using conventional colonography as the reference st and ard . At CT colonography , fecal residue was evaluated . Patients were interviewed to determine discomfort , side effects , sleep quality , final opinion on examination comfort , and whether they would be reluctant to undergo the same examination again . RESULTS FT left more fecal residue but improved differentiation from polyps ( FT specificity , 88 % [ 30 of 34 patients ] ; non-FT , 77 % [ 23 of 30 patients ] ) . Sensitivities were comparable : FT , 88 % ( 14 of 16 patients ) ; non-FT , 85 % ( 17 of 20 patients ) . FT significantly reduced discomfort , side effects , and sleep disturbance , and result ed in an improved final opinion of how comfortable the examination was ( P < .05 ) . Although FT improved patient willingness to repeat the examination , this improvement was not statistically significant ( P > .05 ) . CONCLUSION FT offers the patient a well-tolerated preparation and improves specificity , with improved differentiation of polyps from residual stool BACKGROUND AND AIMS We prospect ively compared the performance of low-dose multidetector computed tomographic colonography ( CTC ) without cathartic preparation with that of colonoscopy for the detection of colorectal polyps . METHODS A total of 203 patients underwent low-dose CTC without cathartic preparation followed by colonoscopy . Before CTC , fecal tagging was achieved by adding diatrizoate meglumine and diatrizoate sodium to regular meals . No subtraction of tagged feces was performed . Colonoscopy was performed 3 - 7 days after CTC . Three readers interpreted the CTC examinations separately and independently using a primary 2-dimensional approach using multiplanar reconstructions and 3-dimensional images for further characterization . Colonoscopy with segmental unblinding was used as reference st and ard . The sensitivity of CTC was calculated both on a per-polyp and a per-patient basis . For the latter , specificity , positive predictive values , and negative predictive values were also calculated . RESULTS CTC had an average sensitivity of 95.5 % ( 95 % confidence interval [ CI ] , 92.1%-99 % ) for the identification of colorectal polyps > or = 8 mm . With regard to per-patient analysis , CTC yielded an average sensitivity of 89.9 % ( 95 % CI , 86%-93.7 % ) , an average specificity of 92.2 % ( 95 % CI , 89.5%-94.9 % ) , an average positive predictive value of 88 % ( 95 % CI , 83.3%-91.5 % ) , and an average negative predictive value of 93.5 % ( 95 % CI , 90.9%-96 % ) . Interobserver agreement was high on a per-polyp basis ( kappa statistic range , .61-.74 ) and high to excellent on a per-patient basis ( kappa statistic range , .79-.91 ) . CONCLUSIONS Low-dose multidetector CTC without cathartic preparation compares favorably with colonoscopy for the detection of colorectal polyps BACKGROUND As part of a multicenter , r and omized controlled trial of the efficacy of flexible sigmoidoscopy for the prevention of bowel cancer , an investigation of the predictors of screening interest was carried out in a sub sample of older adults . METHOD The aim of the study was to establish the predictive power of the Health Belief Model ( HBM ) and to evaluate the contribution of HBM elements in mediating the effect of other demographic and health variables which have been found to be associated with screening interest and participation . A total of 5,099 participants were sent a postal question naire which examined screening interest , attitudes toward screen ing ( benefits and barriers ) , perceived bowel cancer risk , bowel cancer worry , bowel symptoms , health status , state anxiety , and optimism . A total of 3,648 question naires were returned completed , giving a response rate of 71.5 % . RESULTS The results showed that threat , barriers , and benefits explained 47 % of the variance in interest . Demographic and health variables were also associated with screening interest , although most of their effect was mediated by the HBM constructs . DISCUSSION This community study in older adults showed a high level of interest in participating in screening . The large sample size provided the opportunity to test the value of the HBM model and to examine mediation of demographic and health variables . The HBM proved to be a good model of screening interest . These results further our underst and ing of the decision processes in participating in cancer screening and point to directions to increase the level of participation in community sample BACKGROUND Response rates , patient sample characteristics , and patient satisfaction ratings were compared between two surveying methods : ( 1 ) surveys completed at the physician office site ( on-site surveying ) , and ( 2 ) surveys mailed to patient homes following the encounter ( mail-out/mail-back ) . METHODS Surveying was completed at three physician practice s within a 214-physician medical practice . Patients with physician appointments during four-hour time blocks were r and omly split to receive either on-site or mail-based satisfaction surveys . RESULTS Participants younger than 45 years of age provided much higher satisfaction ratings on site than they did by mail ( p < .0001 ) , and participants older than 45 years of age reported satisfaction levels consistently whether on site or by mail . Both age groups reported higher satisfaction with " people aspects " of care on site than they did by mail ( p < .001 ) . DISCUSSION On-site methods may yield satisfaction results that are biased in a positive direction for younger patients and for all patients in which social desirability pressures are prominent . Therefore , organizations that rely on such information may have an inflated view of the patient 's satisfaction with their care delivery experience . Secondly , because the differences in ratings are the greatest for the " people aspects " of care , if improvement efforts are prioritized on the basis of these rapid results , the wrong priorities may be set The purpose was to evaluate low-dose CT colonography without cathartic cleansing in terms of image quality , polyp visualization and patient acceptance . Sixty-one patients scheduled for colonoscopy started a low-fiber diet , lactulose and amidotrizoic-acid for fecal tagging 2 days prior to the CT scan ( st and ard dose , 5.8–8.2 mSv ) . The original raw data of 51 patients were modified and reconstructed at simulated 2.3 and 0.7 mSv levels . Two observers evaluated the st and ard dose scan regarding image quality and polyps . A third evaluated the presence of polyps at all three mSv levels in a blinded prospect i ve way . All observers were blinded to the reference st and ard : colonoscopy . At three times patients were given question naires relating to their experiences and preference . Image quality was sufficient in all patients , but significantly lower in the cecum , sigmoid and rectum . The two observers correctly identified respectively 10/15 ( 67 % ) and 9/15 ( 60 % ) polyps ≥10 mm , with 5 and 8 false-positive lesions ( st and ard dose scan ) . Dose reduction down to 0.7 mSv was not associated with significant changes in diagnostic value ( polyps ≥10 mm ) . Eighty percent of patients preferred CT colonography and 13 % preferred colonoscopy ( P<0.001 ) . CT colonography without cleansing is preferred to colonoscopy and shows sufficient image quality and moderate sensitivity , without impaired diagnostic value at dose-levels as low as 0.7 mSv OBJECTIVES : Visualizing the entire colorectum in screening is an advantage of colonoscopy , and also computed tomographic ( CT ) colonography , another potentially suitable screening test . Our objective was to compare screening CT colonography and colonoscopy in an asymptomatic average-risk population , and to determine whether providing a choice of tests increased participation . METHODS : One thous and and four hundred subjects from the general community , r and omly selected from the parliamentary electoral roll , were allocated one of three screening groups : colonoscopy , CT colonography , or a choice of these tests , and were sent an institutional letter of invitation . Those with symptoms , colorectal cancer in first-degree relatives , or colonoscopy within 5 yr were ineligible . Outcome measures were participation , acceptability of screening , and yield for advanced colorectal neoplasia in participants . RESULTS : Of the subjects , 24.9 % were ineligible ; the overall participation rate was 18.2 % ( 184/1,009 ) . Participation in each screening group was not different . Both tests were accompanied by the same high levels of acceptability ; most participants found colon Output:

Studies by radiology authors showed a trend towards stronger preference for CTC compared with studies by gastroenterology authors . Symptomatic patients expressed no preference , but screening patients preferred CTC . There was no difference in preferences between studies using “ masked ” and “ unmasked ” preference ascertainment methods . There was no evidence of publication bias , while cumulative and exclusion analysis did not show any temporal trend or dominant study . In conclusion , most included studies reported preference for CTC . On stratified analysis , screening patients preferred CTC while diagnostic patients showed no preference . Studies published in radiology journals showed significantly stronger preference for CTC compared with studies in gastroenterology or general medicine journals

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***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: The Minnesota Coronary Survey was a 4.5-year , open enrollment , single end-time , double-blind , r and omized clinical trial that was conducted In six Minnesota state mental hospitals and one nursing home . It Involved 4393 Institutionalized men and 4664 Institutionalized women . The trial compared the effects of a 39 % fat control diet ( 18 % saturated fat , 5 % polyunsaturated fat , 16 % monounsaturated fat , 446 mg dietary cholesterol per day ) with a 38 % fat treatment diet ( 9 % saturated fat , 15 % polyunsaturated fat , 14 % monounsaturated fat , 166 mg dietary cholesterol per day ) on serum cholesterol levels and the Incidence of myocardlal Infa rct ions , sudden deaths , and all-cause mortality . The mean duration of time on the diets was 384 days , with 1568 subjects consuming the diet for over 2 years . The mean serum cholesterol level In the pre-admission period was 207 mg/dl , falling to 175 mg/dl in the treatment group and 203 mg/dl In the control group . For the entire study population , no differences between the treatment and control groups were observed for cardiovascular events , cardiovascular deaths , or total mortality . A favorable trend for all these end-points occurred In some younger age groups CONTEXT Obesity in the United States has increased dramatically during the past several decades . There is debate about optimum calorie balance for prevention of weight gain , and proponents of some low-carbohydrate diet regimens have suggested that the increasing obesity may be attributed , in part , to low-fat , high-carbohydrate diets . OBJECTIVES To report data on body weight in a long-term , low-fat diet trial for which the primary end points were breast and colorectal cancer and to examine the relationships between weight changes and changes in dietary components . DESIGN , SETTING , AND PARTICIPANTS R and omized intervention trial of 48,835 postmenopausal women in the United States who were of diverse background s and ethnicities and participated in the Women 's Health Initiative Dietary Modification Trial ; 40 % ( 19,541 ) were r and omized to the intervention and 60 % ( 29,294 ) to a control group . Study enrollment was between 1993 and 1998 , and this analysis includes a mean follow-up of 7.5 years ( through August 31 , 2004 ) . INTERVENTIONS The intervention included group and individual sessions to promote a decrease in fat intake and increases in vegetable , fruit , and grain consumption and did not include weight loss or caloric restriction goals . The control group received diet-related education material s. MAIN OUTCOME MEASURE Change in body weight from baseline to follow-up . RESULTS Women in the intervention group lost weight in the first year ( mean of 2.2 kg , P<.001 ) and maintained lower weight than control women during an average 7.5 years of follow-up ( difference , 1.9 kg , P<.001 at 1 year and 0.4 kg , P = .01 at 7.5 years ) . No tendency toward weight gain was observed in intervention group women overall or when stratified by age , ethnicity , or body mass index . Weight loss was greatest among women in either group who decreased their percentage of energy from fat . A similar but lesser trend was observed with increases in vegetable and fruit servings , and a nonsignificant trend toward weight loss occurred with increasing intake of fiber . CONCLUSION A low-fat eating pattern does not result in weight gain in postmenopausal women . Clinical Trial Registration Clinical Trials.gov , NCT00000611 BACKGROUND Dietary factors and very-long-chain n-3 polyunsaturated fatty acids ( n-3 PUFAs ) may influence the atherothrombotic process . Elevated concentrations of circulating cell adhesion molecules , thrombomodulin ( TM ) , von Willebr and factor ( vWF ) , and tissue-type plasminogen activator antigen ( tPAag ) are related to atherothrombotic cardiovascular disease . OBJECTIVE The r and omized Diet and Omega-3 Intervention Trial ( DOIT ) targeted a comparison of the effect of 3-y dietary counseling , n-3 PUFA supplementation ( 2.4 g/d ) , or both on circulating markers of endothelial activation . DESIGN The study included 563 elderly men with long-st and ing hyperlipidemia . The men were r and omly assigned by factorial design into 4 groups : control ( no dietary counseling and placebo capsules ) , dietary counseling ( and placebo capsules ) , n-3 PUFA supplementation ( no dietary counseling ) , and dietary counseling and n-3 PUFA supplementation . RESULTS Serum concentrations of fatty acids reflected good compliance . Dietary counseling was followed by significantly reduced concentrations of soluble intercellular adhesion molecule 1 ( sICAM-1 ; P < 0.001 ) , sTM ( P = 0.004 ) , and tPAag ( P < 0.001 ) than in subjects without dietary counseling . After n-3 PUFA supplementation , significantly reduced concentrations of sICAM-1 ( P < 0.001 ) and sTM ( P = 0.006 ) were observed when compared with subjects receiving placebo capsules . An increase in tPAag was not significantly different from that observed in subjects receiving placebo capsules . For sICAM-1 , a significant effect was observed for both interventions combined . CONCLUSIONS Each intervention ( dietary counseling or n-3 PUFA supplements ) reduced sTM and sICAM-1 concentrations , indicating decreased endothelial activation . The tPAag increase in the groups not receiving dietary counseling ( pooled ) , which indicates progression of atherosclerosis , was significantly counteracted by dietary counseling Effects of specific dietary alterations in patients with radiolucent gallstones treated with ursodeoxycholic acid ( UDCA , 750 mg at bedtime ) were investigated . Patients were allocated r and omly to one of four diets : st and ard ( 500 mg cholesterol/day ) , low-cholesterol ( 250 mg/day ) , added-bran ( 30 g/day ) , or substituted medium-chain triglycerides ( MCT ) oil ( 20 % of fat ) . Dietary intake and good compliance were verified by computerized analysis of dietary diaries . Bile-acid kinetics ( 26 patients ) or secretion of biliary lipids ( 23 other patients ) were determined at enrollment and at 6 and 9 mo , respectively , during treatment . Although MCT further decreased the UDCA-induced decrease in the synthesis of chenodeoxycholic acid , it did not lessen desaturation of bile . Otherwise , compared to the st and ard diet , no experimental diet significantly altered the UDCA-induced increase of the pools of total bile acids and UDCA or the UDCA-induced decrease in synthesis of bile acids and in biliary secretion or saturation of cholesterol . If these dietary manipulations facilitate dissolution of gallstones by UDCA , they do so by other mechanisms BACKGROUND The optimal dietary content and type of fat and carbohydrate for weight management has been debated for decades . OBJECTIVE The objective was to compare the effects of 3 ad libitum diets on the maintenance of an initial weight loss of > or=8 % and risk factors for CVD and diabetes during a 6-mo controlled dietary intervention . DESIGN Nondiabetic overweight or obese [ mean + /- SD body mass index ( in kg/m(2 ) ) : 31.5 + /- 2.6 ] men ( n = 55 ) and women ( n = 76 ) aged 28.2 + /- 4.8 y were r and omly assigned to a diet providing a moderate amount of fat ( 35 - 45 % of energy ) and > 20 % of fat as monounsaturated fatty acids ( MUFA diet ; n = 54 ) , to a low-fat ( 20 - 30 % of energy ) diet ( LF diet ; n = 51 ) , or to a control diet ( 35 % of energy as fat ; n = 26 ) . Protein constituted 10 - 20 % of energy in all 3 diets . All foods were provided free of charge from a purpose -built supermarket . RESULTS More subjects dropped out of the MUFA ( 28 % ) group than out of the LF group ( 16 % ) and control group ( 8 % ) ( MUFA compared with control : P < 0.05 ) . All groups regained weight ( MUFA : 2.5 + /- 0.7 kg ; LF : 2.2 + /- 0.7 kg ; and control : 3.8 + /- 0.8 kg ; NS ) . Body fat regain was lower in the LF ( 0.6 + /- 0.6 % ) and MUFA ( 1.6 + /- 0.6 % ) groups than in the control group ( 2.6 + /- 0.5 % ) ( P < 0.05 ) . In the MUFA group , fasting insulin decreased by 2.6 + /- 3.5 pmol/L , the homeostasis model assessment of insulin resistance by 0.17 + /- 0.13 , and the ratio of LDL to HDL by 0.33 + /- 0.13 ; in the LF group , these variables increased by 4.3 + /- 3.0 pmol/L ( P < 0.08 ) and 0.17 + /- 0.10 ( P < 0.05 ) and decreased by 0.02 + /- 0.09 ( P = 0.005 ) , respectively ; and in the control group , increased by 14.0 + /- 4.3 pmol/L ( P < 0.001 ) , 0.57 + /- 0.17 ( P < 0.001 ) , and 0.05 + /- 0.14 ( P = 0.036 ) , respectively . Dietary adherence was high on the basis of fatty acid changes in adipose tissue . CONCLUSIONS Diet composition had no major effect on preventing weight regain . However , both the LF and MUFA diets produced less body fat regain than did the control diet , and the dropout rate was lowest in the LF diet group , whereas fasting insulin decreased and the homeostasis model assessment of insulin resistance and ratio of LDL to HDL improved with the MUFA diet . This trial was registered at clinical trials.gov as NCT00274729 BACKGROUND Dietary fat has been implicated as a risk factor for cardiovascular disease and obesity . OBJECTIVE We evaluated the effect on body weight , body fat , lipids , glucose , and insulin of replacing dietary fat with olestra in moderately obese men . DESIGN Forty-five healthy overweight men were r and omly assigned to 1 of 3 diets : control diet ( 33 % fat ) , fat-reduced diet ( 25 % fat ) , or fat-substituted diet ( one-third of dietary fat replaced by olestra to achieve a diet containing 25 % metabolizable fat ) . Body fat was measured by dual-energy X-ray absorptiometry and visceral and subcutaneous abdominal fat by computed tomography . RESULTS Thirty-six men completed the 9-mo study . Body weight and body fat in the fat-substituted group declined by a mean ( + /- SEM ) of 6.27 + /- 1.66 and 5.85 + /- 1.34 kg , respectively , over 9 mo compared with 3.8 + /- 1.34 and 3.45 + /- 1.0 kg in the control group and 1.79 + /- 0.81 and 1.68 + /- 0.75 kg in the fat-reduced diet group . At 9 mo , the mean difference in body fat between the fat-reduced and fat-substituted groups was -4.19 + /- 1.19 kg ( 95 % CI : -6.57 , -1.81 ) , that between the control and fat-substituted groups was -2.55 + /- 1.21 kg ( -0.13 , -4.97 ) , and that between the control and fat-reduced groups was 1.63 + /- 1.18 kg ( 3.96 , -0.70 ) . The men eating the fat-reduced diet asked for almost no extra foods , in contrast with the significantly higher requests ( P < 0.05 ) from both of the other 2 groups . CONCLUSION Replacement of dietary fat with olestra reduces body weight and total body fat when compared with a 25%-fat diet or a control diet containing 33 % fat This r and omised controlled trial examined anthropometric changes and cardiovascular benefits of six months of weight management in 110 free living women , aged 18–68 y and BMI 25–50 kg/m2 , who received 1200 kcal/d diet treatments of either high ( 58 % energy , n=57 ) or low ( 35 % energy , n=53 ) carbohydrate ( CHO ) content . Body weight , plasma total Output:

Lower weight gain in the low fat arm compared with the control arm was consistent across trials , but the size of the effect varied . Metaregression suggested that greater reduction in total fat intake and lower baseline fat intake were associated with greater relative weight loss , explaining most of the heterogeneity . The significant effect of a low fat diet on weight was not lost in sensitivity analyses ( including removing trials that expended greater time and attention on low fat groups ) . GRADE assessment suggested high quality evidence for the relation between total fat intake and body weight in adults . There is high quality , consistent evidence that reduction of total fat intake has been achieved in large numbers of both healthy and at risk trial participants over many years . Evidence supports a similar effect in children and young people

MS2_1shot434

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: In a multicentre placebo-controlled double-blind study 61 patients with spinal cord injuries and detrusor hyperreflexia were treated : 20 mg trospium chloride was given twice daily over a period of 3 weeks . Pre- and posttreatment urodynamic measurements demonstrated large improvements in maximum cystometric capacity ( mean = 138.1 ml ) , decreased maximum detrusor pressure ( mean = -37.8 cm H2O ) and an increase in compliance ( mean = 12.1 ml/cm H2O ) in the treatment group . Urodynamic parameters in the placebo group remained substantially unchanged . Comparisons between the two groups revealed highly significant differences for these parameters ( all , p less than 0.001 ) . No effect on maximum flow rate and residual urine was detected in either group . The incidence of spontaneously reported side-effects was extremely low and comparable for both groups Aims of the study : The aim of this double-blind , r and omised , prospect i ve , multicentre trial was to evaluate the efficacy of propiverine in patients suffering from detrusor hyperreflexia caused by spinal cord injury in comparison to placebo . Study design : The treatment period of 14 days comprised visits at baseline ( V1 ) and after 14 days treatment ( V2 ) . Fifteen mg propiverine t.i.d . or placebo t.i.d . were administered as medication . The following efficacy parameters were adopted : the urodynamic parameters maximal cystometric bladder capacity , bladder volume on onset of the first as well as duration and amplitude of the maximum detrusor contraction , bladder compliance and residual urine , and subjective assessment of efficacy by physicians . For the evaluation of the safety of propiverine the incidence rate of adverse events by directly question ing as well as laboratory parameters were investigated . For biometrical evaluation t-test for independent groups was applied . Results : One hundred and thirteen patients were investigated . The maximal cystometric bladder capacity increased significantly in the propiverine group , on average by 104 ml ( V1 : 262±132 ml . V2 : 366±143 ml , P<0.001 ) . The changes in bladder capacity during the first contraction and the maximum detrusor contraction in the verum group were both statistically significant . The bladder compliance documented a more pronounced increase under propiverine in comparison to placebo . Residual urine increased by 37±71 ml in the propiverine group , significantly more than in the placebo group ( P=0.01 ) . Sixty-three per cent of the patients expressed subjectively an improvement under propiverine in comparison with 23 % of the placebo group . Expected anticholinergic adverse events occurred : dryness of the mouth ( 37 % in the verum and 8 % in the placebo group ) , accommodation disorders ( 28 % and 2 % respectively ) . Nausea , constipation , headache , dizziness , tiredness and palpitations were reported in almost comparable incidence rates between 3 and 13 % in both treatment groups . Eight drop-outs were registered in the propiverine group ( five due to adverse events ) and three in the placebo group ( one due to adverse events ) . The laboratory parameters revealed no changes . Conclusion : Propiverine proved its efficacy in detrusor hyperreflexia with regard to the urodynamic parameters of the maximal cystometric bladder capacity and detrusor contractility . Anticholinergic adverse events such as dryness of the mouth and accommodation disorders were considered being tolerable . The increase in residual urine reflects the therapeutically desired effect of detrusor relaxation because the majority of patients normally practise intermittent catheterisation for bladder emptying Abstract Objective : To compare tolterodine with oxybutynin and placebo in people with neuragenie detrusor overactivity . Design : Prospect i ve , r and omized , double-blind , crossover trial plus open-label comparative stage . Participants : Ten participants with neuragenie detrusor overactivity due to spinal cord injury or multiple sclerosis who usedintermittent catheterization . Methods : Bladder capacity on cystometrogram , a 10-day record of catheterization volumes , number of incontinent episodes perday , and perceived dry mouth using a visual analog scale ( VAS ) were measured for the following : ( a ) a blinded comparison : tolterodine , 2 mg twice daily , vs placebo , twice daily ; and ( b ) an unblinded comparison : oxybutynin vs tolterodine , each atself-selected doses ( SSDs ) . Results : Tolterodine , 2 mg twice daily , was superior to placebo in enhancing catheterization volumes ( P<0.0005 ) and reducingincontinence ( P<0.001 ) , but was comparable with placebo in cystometric bladder capacity . Efficacy of tolterodine SSD wascomparable with oxybutynin SSD with regard to catheterization volumes , degree of incontinence , and cystometric bladder capacity . The side effect profile ( dry mouth ) was comparable between tolterodine , 2 mg twice daily , and placebo , but differed significantlywhen comparing tolterodine SSD with oxybutynin SSD ( P<0.05 ) . Conclusion : T olterodine , when used at SSDs , is comparable with oxybutynin at SSDs in enhancing bladder volume and improvingcontinence , but with less dry mouth . T olterodine at the recommended dosage of 2 mg twice daily improves incontinence and bladdervolumes compared with placebo , and without significant dry mouth . Larger doses of tolterodine may be needed to achieve best effectin this population , but further studies are required Hyperreflexia is the most common urological finding in patients with multiple sclerosis . A prospect i ve r and omized study was done to compare the effectiveness of 2 commonly used drugs , oxybutynin and propantheline . Of the 34 patients entered into the trial 19 were treated with oxybutynin and 15 with propantheline . The urological symptoms ( frequency , nocturia , hesitancy , urgency and urge incontinence ) were grade d according to severity from 0 to 3 . Patients with urinary infection were excluded . Urodynamic examination , consisting of cystometrography and electromyography , was performed in all patients before treatment . Both groups of patients had comparable neurological , urological and urodynamic status before treatment . In 4 patients ( 21 per cent ) treated with oxybutynin and in 4 ( 27 per cent ) treated with propantheline side effects were so severe that the treatment had to be discontinued . Symptomatic response to oxybutynin was good in 10 patients ( 67 per cent ) , fair in 2 ( 13 per cent ) and poor in 3 ( 20 per cent ) . Propantheline produced good symptomatic results in 4 patients ( 36 per cent ) , fair in 1 ( 9 per cent ) and poor in 6 ( 55 per cent ) . The mean increase in maximum cystometric capacity on cystometrography was significantly larger in the oxybutynin group than in the propantheline group ( 144 + /- 115 versus 35 + /- 101 ) . Our results indicate that oxybutynin is more effective than propantheline in the treatment of detrusor hyperreflexia in patients with multiple sclerosis PURPOSE About 15 % to 20 % of patients with detrusor hyperreflexia do not benefit from oral oxybutynin regimens , frequently because of unpleasant side effects . Several reports indicate that intravesical oxybutynin is effective in many of these patients but there are some who still fail to respond . MATERIAL S AND METHODS A select group of 10 adults with detrusor hyperreflexia unresponsive to st and ard oral and intravesical oxybutynin regimens were treated at weekly intervals with 5 mg . oxybutynin orally , or 5 mg . oxybutynin in 100 ml . intravesically for 60 minutes of passive diffusion and for 30 minutes with 5 mA. electrical current . Each treatment ( plus oral placebo and 2 intravesical controls ) was associated with an 8-hour , full urodynamic monitoring session , and periodic blood and bladder content sampling . RESULTS There was no significant objective improvement with oral or intravesical passive diffusion oxybutynin . Conversely there was significant improvement in 5 of 6 objective urodynamic measurements with intravesical electromotive oxybutynin . Plasma profiles were a single peak and decay following oral oxybutynin and 2 distinct peaks with intravesical passive diffusion and electromotive oxybutynin . Area under the curve for intravesical passive diffusion were 709 ng . per 8 hours versus oral 1,485 ( p < 0.05 ) versus intravesical electromotive 2,781 ( p < 0.001 ) . Bladder content sample s confirmed oxybutynin absorption . Oral oxybutynin caused anticholinergic side effects in 7 of 10 patients . There were no side effects with intravesical passive diffusion or electromotive administrations . CONCLUSIONS Accelerated intravesical administration results in greater bioavailability and increased objective benefits without side effects in previously unresponsive patients compared with oral and intravesical passive diffusion oxybutynin administration Study design : Double-blind , r and omised , multicentre study . Objectives : Efficacy and tolerability of propiverine extended-release ( ER ) compared with immediate-release ( IR ) were evaluated in patients with proven neurogenic detrusor overactivity ( NDO ) . Setting : Six Spinal Cord Injury Units located in Austria , Germany and Romania . Methods : Propiverine ER 45 mg s.i.d . or IR 15 mg t.i.d . were administered in patients with proven NDO . Outcomes were assessed at baseline ( V1 ) , and after 21 days of treatment ( V2 ) : Reflex volume served as primary , leak point volume and maximum detrusor pressure as secondary efficacy outcomes , treatment-related adverse events as tolerability outcomes . Results : Sixty-six patients with proven NDO were enrolled . Reflex volume ( ml ) increased significantly in the IR ( V1 : 100.9 , V2 : 202.9 ) and in the ER ( V1 : 89.8 , V2 : 180.3 ) group , no significant intergroup difference . Leak point volume increased , and maximum detrusor pressure decreased significantly in both groups , no significant intergroup differences . The percentage of patients presenting with incontinence was reduced by 14 % in the IR and by 39 % in the ER group , the difference is significant . Treatment-related adverse events manifested in 42 and 36 % following propiverine IR and ER , respectively . Conclusion : The urodynamic efficacy outcomes demonstrated both galenic formulations to be equieffective . However , following propiverine ER 45 mg s.i.d . higher continence rates compared with propiverine IR 15 mg t.i.d . were achieved , possibly indicative of more balanced plasma-levels . A slight tendency for superior tolerability outcomes of propiverine ER compared with IR was demonstrated . Sponsorship : The study was sponsored by an unrestricted educational grant of APOGEPHA Arzneimittel GmbH , Dresden , Germany Abstract Objective : This study evaluated the effects and tolerability of extended-release oxybutynin chloride on the frequency of voiding and catheterization and urodynamic capacity in spinal cord injury ( SCI ) patients with defined detrusor hyperreflexia . Methods : This was a 1 2-week , prospect i ve , dose-titration study of extended-release oxybutynin ( oxybutynin XL ) . SCI patients with urodynamically defined detrusor hyperreflexia were recruited for this study . Following a 7 -day washout period , patients were evaluated via video-urodynamic study and then treatment was initiated at a dosage of 1 0 mg per day . Dosage was increased in weekly intervals to a maximum of 30 mg per day . Micturation frequency diaries and urodynamics were completed at baseline and repeated at week 1 2 . Tolerability information was collected at each follow-up visit . Results : Ten patients ( mean age = 49 years ) with complete or incomplete SCI were enrolled . Participants reported clinical improvement ( decreased urinary frequency and fewer incontinence episodes ) with oxybutynin therapy following titration to 30 mg per day . All patients chose a final effective dosage of greater than 1 0 mg , with 4 patients taking the maximum of 3 0 mg per day . Mean cystometric bladder capacity increased from 2 7 4 mL to 3 80 mL ( P = 0.008 ) . No patient experienced serious adverse events during the 12-week study . Conclusion : Oxybutynin XL is safe and effective in patients with detrusor hyperreflexia secondary to SCI . The onset of clinical efficacy occurs within 1 week , and daily dosages up to 30 mg are well tole rated Objective To compare the efficacy of a controlled‐release ( CR ) formulation of oxybutynin with that of conventional oxybutynin in patients with detrusor instability or detrusor hyper‐reflexia whose symptoms were stabilized on conventional oral oxybutynin tablets INTRODUCTION AND OBJECTIVES The dosage of the antimuscarinic drugs : Tolterodine ER or Trospium was increased to a higher-than-recommended dosage in patients where the manufacturer 's recommended dosage had failed . All patients were suffering from neurogenic detrusor overactivity incontinence . Tolerability and success were evaluated in the present study . MATERIAL S AND METHODS Twenty-one patients with neurogenic Output:

The dry-mouth rates were statistically significantly higher with anticholinergics , with no difference in withdrawals because of adverse events . There was no statistically significant difference in any of the outcomes between oxybutynin and other anticholinergics or among different doses and preparations of anticholinergic drugs . CONCLUSIONS Compared with placebo , anticholinergic treatment in patients with NDO is associated with better patient-reported cure/improvement and significant reduction of maximum detrusor pressure ; however , there is a higher incidence of adverse events . None of the anticholinergic drugs or different dosages assessed in this review was superior to another

MS2_1shot435

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: In most people the left hemisphere of the brain is dominant for language . Because of the increased incidence of atypical right-hemispheric language in left-h and ed neurological patients , a systematic association between h and edness and dominance has long been suspected . To clarify the relationship between h and edness and language dominance in healthy subjects , we measured lateralization directly by functional transcranial Doppler sonography in 326 healthy individuals using a word-generation task . The incidence of right-hemisphere language dominance was found to increase linearly with the degree of left-h and edness , from 4 % in strong right-h and ers ( h and edness = 100 ) to 15 % in ambidextrous individuals and 27 % in strong left-h and ers ( h and edness = -100 ) . The relationship could be approximated by the formula : f1.gif " BORDER="0">. These results clearly demonstrate that the relationship between h and edness and language dominance is not an artefact of cerebral pathology but a natural phenomenon Objective : To evaluate the reliability of temporal and frontal functional MRI ( fMRI ) activation for the assessment of language dominance , as compared with the Wada test . Patients and Methods : Ten patients with temporal lobe epilepsy were studied using blood oxygen level dependent fMRI and echoplanar imaging ( 1.5-T ) . Three tasks were used : semantic verbal fluency , covert sentence repetition , and story listening . Data were analyzed using pixel by pixel autocorrelation and cross-correlation . fMRI laterality indices were defined for several regions of interest as the ratio ( L − R)/(L + R ) , L being the number of activated voxels in the left hemisphere and R in the right hemisphere . Wada laterality indices were defined as the difference in the percentages of errors in language tests between left and right carotid injections . Results : Semantic verbal fluency : The asymmetry of frontal activation was correlated with Wada laterality indices . The strongest correlation was observed in the pre central /middle frontal gyrus/inferior frontal sulcus area . Story listening : The asymmetry of frontal , but not temporal , activation was correlated with Wada laterality indices . Covert sentence repetition : No correlation was observed . Conclusions : There was a good congruence between hemispheric dominance for language as assessed with the Wada test and fMRI laterality indices in the frontal but not in the temporal lobes . The story listening and the covert sentence repetition tasks increased the sensitivity of detection of posterior language sites that may be useful for brain lesion surgery PURPOSE Selective amygdalohippocampectomy ( SAH ) is a surgical treatment option for patients with medically intractable mesial temporal lobe epilepsy . In contrast to st and ard anterior temporal lobectomy , resection of unaffected tissue is limited , although it achieves equal seizure outcomes in selected patients . In SAH , the mesial structures can be approached by different routes , the transsylvian approach and the transcortical approach . Advantages or disadvantages with respect to postoperative cognitive outcome are still a matter of debate . METHODS Eighty r and omized patients were included in the analyses . In 41 patients , the transsylvian approach , and in 39 patients , the transcortical approach was performed . All patients received comprehensive neuropsychological testing of verbal and nonverbal memory , attention , and executive functions before and 6 months or 1 year after SAH . RESULTS Seventy-five percent of patients became completely seizure free with no difference depending on the chosen approach . Repeated measures multivariate analysis of variance ( MANOVA ) showed that cognitive outcomes after both approaches were essentially the same . The only exception was phonemic fluency , which was significantly improved after transcortical but not after transsylvian SAH . CONCLUSIONS The results indicate that either surgical approach can be chosen independent of cognitive outcome criteria . Improvement in phonemic fluency after transcortical SAH may reflect selective normalization of cognitive function after epilepsy surgery , whereas frontal lobe manipulation might have hindered recovery of this function after transsylvian SAH OBJECT The aim of this study was to analyze the national health care burden of patients diagnosed with epilepsy in the US and to analyze any changes in the length of stay , mean charges , in-hospital deaths ( mortality ) , and disposition at discharge . METHODS A retrospective review of the Nationwide Inpatient Sample ( NIS ) data base for epilepsy admissions was completed for the years from 1993 to 2008 . The NIS is maintained by the Agency for Healthcare Research and Quality and represents a 20 % r and om stratified sample of all discharges from nonfederal hospitals within the U.S. Patients with epilepsy were identified using ICD-9 codes beginning with 345.XX . Approximately 1.1 million hospital admissions were identified over a span of 15 years . RESULTS Over this 15-year period ( between 1993 and 2008 ) , the average hospital charge per admission for patients with epilepsy has increased significantly ( p < 0.001 ) from $ 10,050 to $ 23,909 , an increase of 137.9 % . This is in spite of a 33 % decrease in average length of stay from 5.9 days to 3.9 days . There has been a decrease in the percentage of in-hospital deaths by 57.9 % and an increase in discharge to outside medical institutions . CONCLUSIONS The total national charges associated with epilepsy in 2008 were in excess of $ 2.7 billion ( U.S. dollars , normalized ) . During the studied period , the cost per day for patients rose from $ 1703.39 to $ 6130.51 . In spite of this drastic increase in health care cost to the patient , medical and surgical treatment for epilepsy has not changed significantly , and epilepsy remains a major source of morbidity Over an 18-month period , all incident cases of neurological disorders were ascertained prospect ively in an unselected urban population based in 13 general practice s in the London area by a General Practice Linkage Scheme with the National Hospital for Neurology and Neurosurgery . In three of these practice s , the lifetime prevalence of neurological disorders was also assessed . A population of 100 230 patients registered with participating general practice s was followed prospect ively for the onset of neurological disorders . Multiple methods of case finding were used to maintain accuracy . The age- and sex-adjusted incidence rates of neurological disorders were calculated . The lifetime prevalence of neurological disorders was surveyed in 27 658 of the patients . The age- and sex-adjusted incidence rates were calculated for major neurological conditions . [ These are expressed as rates per 100 000 persons per annum , with 95 % confidence intervals ( CI ) in parentheses ] . The commonest of these were first cerebrovascular events , 205 ( CI : 183 , 230 ) ; shingles , 140 ( CI : 104 , 184 ) ; diabetic polyneuropathy , 54 ( CI : 33 , 83 ) ; compressive neuropathies , 49 ( CI : 39 , 61 ) ; epilepsy , 46 ( CI : 36 , 60 ) ; Parkinson 's disease , 19 ( CI : 12 , 27 ) ; peripheral neuropathies , 15 ( CI : 9 , 23 ) ; CNS infections , 12 ( CI : 5 , 13 ) ; post-herpetic neuralgia , 11 ( CI : 6 , 17 ) ; and major neurological injuries , 10 ( CI : 4 , 11 ) . Lifetime prevalence rates are also reported ( expressed as rate per 1000 persons with 95 % CI ) . The most prevalent conditions were : completed stroke , 9 ( CI : 8 , 11 ) ; transient ischaemic attacks , 5 ( CI : 4 , 6 ) ; active epilepsy , 4 ( CI : 4 , 5 ) ; congenital neurological deficit , 3 ( CI : 3 , 4 ) ; Parkinson 's disease , 2 ( CI : 1 , 3 ) ; multiple sclerosis , 2 ( CI : 2 , 3 ) ; diabetic polyneuropathy , 2 ( CI : 1 , 3 ) ; compressive mononeuropathies , 2 ( CI : 2 , 3 ) ; and sub-arachnoid haemorrhage , 1 ( CI : 0.8 , 2 ) . Overall , the onset of 625 neurological disorders was observed per 100 000 population annually . Six percent of the population had at some time had a neurological disorder . This is the first study of the incidence and lifetime prevalence of neurological disorders in recent times ; we found that these disorders give rise to significant morbidity in the community The aim of this work was to determine whether productive and perceptive language functions are differentially affected in homogeneous groups of epilepsy patients with right and left temporal lobe epilepsy ( TLE ) . Eighteen patients with left TLE , 18 with right TLE , and 17 healthy volunteers were studied using fMRI during performance of three tasks assessing the productive and perceptive aspects of language ( covert semantic verbal fluency , covert sentence repetition , and story listening ) . Hemispheric dominance for language was calculated in the frontal and temporal regions using laterality indices ( LI ) . Atypical lateralization was defined as a right-sided LI ( LI<-0.20 ) in the frontal lobes during the verbal fluency task or in the temporal lobes during the story listening task . Control subjects and right TLE patients demonstrated a strong left lateralization for language in the frontal lobes during the fluency task , whereas activation was less lateralized to the left hemisphere in left TLE patients , although the difference did not reach significance . In the story listening and the repetition tasks , activation was significantly more right sided in the temporal lobes of patients with left TLE . Atypical language representation was found in 19 % of TLE patients ( five left and two right TLE ) . The shift toward the right hemisphere was significantly larger in the temporal than the frontal lobes in patients with atypical language lateralization compared to TLE patients with a typical language lateralization . Neuropsychological performances of patients with atypical language patterns were better than those of patients with typical patterns , suggesting that this reorganization may represent a compensatory mechanism WE examined whether 53 adult non-aphasic patients with either left ( 22 ) or right temporal lobe lesions ( 31 ) demonstrate dissociable patterns of hemispheric asymmetries in category-specific word fluency tasks . The patients were asked to articulate as many appropriate words as possible within 60 or 90 s in response to six target categories . There was no effect of patient groups on the overall fluency . However , patients with a leftsided temporal lobe lesion were impaired retrieving words to ‘ initial letters ’ and to the category ‘ animals ’ . Right temporal lobe patients were impaired retrieving ‘ tools ’ and words referring to specific visual attributes . There were no fluency differences for ‘ food-supermarket goods ’ and ‘ flat interior ’ . We conclude that temporal lobe damage can result in category-specific impairments in word retrieval depending on the affected hemisphere BACKGROUND R and omized trials of surgery for epilepsy have not been conducted , because of the difficulties involved in design ing and implementing feasible studies . The lack of data supporting the therapeutic usefulness of surgery precludes making strong recommendations for patients with epilepsy . We conducted a r and omized , controlled trial to assess the efficacy and safety of surgery for temporal-lobe epilepsy . METHODS Eighty patients with temporal-lobe epilepsy were r and omly assigned to surgery ( 40 patients ) or treatment with antiepileptic drugs for one year ( 40 patients ) . Optimal medical therapy and primary outcomes were assessed by epileptologists who were unaware of the patients ' treatment assignments . The primary outcome was freedom from seizures that impair awareness of self and surroundings . Secondary outcomes were the frequency and severity of seizures , the quality of life , disability , and death . RESULTS At one year , the cumulative proportion of patients who were free of seizures impairing awareness was 58 percent in the surgical group and 8 percent in the medical group ( P<0.001 ) . The patients in the surgical group had fewer seizures impairing awareness and a significantly better quality of life ( P<0.001 for both comparisons ) than the patients in the medical group . Four patients ( 10 percent ) had adverse effects of surgery . One patient in the medical group died . CONCLUSIONS In temporal-lobe epilepsy , surgery is superior to prolonged medical therapy . R and omized trials of surgery for epilepsy are feasible and appear to yield precise estimates of treatment effects OBJECTIVES The correlation between clinical measures of memory and subjectively reported memory is often poor . Regarding this we investigated in patients with temporal lobe epilepsy ( TLE ) whether there is evidence that persons mistake other cognitive performances for memory due to subjective memory theories . METHODS a neuropsychological test battery comprising measures of attention , verbal/figural memory and other visual or language related functions was applied in patients with left ( L-TLE , n=24 ) or right temporal lobe epilepsy ( R-TLE , n=21 ) and healthy volunteers ( n=20 ) . In addition , subjective self- and other-reported memories were assessed by the subjective memory question naire ( SMQ ) . RESULTS subjective measures as well as objective measures indicate significant cognitive impairment in TLE and in L-TLE in particular . Self-reports and other-reports are interrelated but only self-reported memory correlates significantly with objective memory performance . Regression analysis indicates that self-reported memory is best predicted by word fluency followed by ver Output:

Both patients with left- and right sided TLE were impaired on SVF and PVF compared to HC . Patients with left-sided TLE were slightly more impaired than patients with right-sided TLE . Patients with FLE showed a larger impairment in PVF than patients with TLE , whereas on SVF there was no difference between FLE and TLE . Semantic verbal fluency might not differentiate between FLE and TLE . While verbal fluency impairment was anticipated , especially in left-sided TLE and FLE patients , the impairment in patients with right-sided TLE was larger than expected .

MS2_1shot436

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: PURPOSE Several retrospective analyses have suggested that obese men with prostate cancer treated with external beam radiotherapy ( EBRT ) have outcomes inferior to those of normal-weight men . However , a recently presented analysis for the first time challenged this association between body mass index ( BMI ) and treatment failure . It is therefore important to provide further data on this issue . METHODS AND MATERIAL S This was a retrospective analysis of 564 men treated with risk-adapted conformal EBRT at a single institution . Low-risk patients received EBRT alone , and the other patients received EBRT plus endocrine treatment . In addition , high-risk patients were treated to higher EBRT doses ( 74 Gy ) . A rectal balloon catheter for internal immobilization , which can be identified on portal images , was used in 261 patients ( 46 % ) . Thus , localization did not rely on bony l and marks alone in these cases . RESULTS The median BMI was 26 , and 15 % of patients had BMI ≥30 . Neither univariate nor multivariate analyses detected any significant impact of BMI on biochemical relapse , prostate cancer-specific survival , or overall survival . The 5-year biochemical relapse rate was 21 % and prostate cancer-specific survival 96 % . CONCLUSIONS The present analysis of a large cohort of consecutively treated patients suggests that efforts to reduce prostate movement and geographic miss might result in comparable outcomes in obese and normal-weight patients PURPOSE Several lines of evidence suggest that diet and weight gain may be important environmental factors implicated in prostate carcinogenesis , especially in tumor progression . The purpose of this study was to evaluate obesity at different ages in a well-characterized cohort of prostate cancer patients treated with prostatectomy and to develop a prognostic model that incorporates body mass index ( BMI ) as a measure of obesity . EXPERIMENTAL DESIGN We carried out a prospect i ve study of 526 patients registered at the M.D. And erson Cancer Center from 1992 to 2001 . Kaplan-Meier and Cox proportional hazard analyses were done . RESULTS During an average follow-up of 54 months , 97 ( 18 % ) post-prostatectomy patients experienced biochemical failure . Patients who were obese ( BMI > or = 30 kg/m2 ) at diagnosis had a higher rate of biochemical failure than nonobese men ( P = 0.07 ) . Those obese at 40 years had an even greater rate of biochemical failure ( P = 0.001 ) . Higher BMI at diagnosis [ hazard ratio ( HR ) , 1.07 ; P = 0.01 ] and Gleason score = 7(4 + 3 ) and > or = 8 ( HR , 3.9 ; P = 0.03 and HR , 10.0 ; P < or = 0.001 , respectively ) remained significant independent predictors of biochemical failure in multivariate analysis . Men who gained weight at the greatest rate ( > 1.5 kg/y ) between 25 years and diagnosis progressed significantly sooner ( mean time , 17 months ) than those who exhibited a slower weight gain ( mean time , 39 months ; P(trend ) = 0.005 ) . The inclusion of obesity to the clinical nomogram improved performance . CONCLUSIONS Our findings vali date the importance for a role of obesity in prostate cancer progression and suggest a link to the biological basis of prostate cancer progression that can be therapeutically exploited Increasing body mass index ( BMI ) is associated with shorter time to prostate‐specific antigen ( PSA ) failure after radical prostatectomy . Whether BMI is associated with time to PSA failure was investigated in men treated with and rogen suppression therapy ( AST ) and radiation therapy ( RT ) for clinical ly localized prostate cancer OBJECTIVE To evaluate the impact of obesity on the outcomes of laparoscopic radical prostatectomy . METHODS AND MATERIAL S In a prospect i ve urologic cancer data base , 765 patients underwent extraperitoneal laparoscopic radical prostatectomy for localized prostate cancer . The patients were categorized into 3 groups of body mass index ( kg/m(2 ) ) : < 25.0 ( n = 276 , 30 % , " normal weight " ) , 25.0 to 30.0 ( n = 365 , 48 % , " overweight " ) and > 30.0 ( n = 124 , 16 % , " obese " ) . We assessed the perioperative , oncological , and functional outcomes in this cohort of patients . Preoperative and postoperative evaluation of continence and erectile function were performed using vali date d question naires . RESULTS Mean operative time was significantly longer in obese patients ( P < .001 ) and blood loss was also more important ( P < .01 ) . The obese patients had the highest likelihood of having aggressive tumors : nonorgan confined prostate cancer ( 49 % , P = .002 ) and Gleason score ≥ 7 ( 80 % , P = .005 ) . The obese group had the higher positive surgical margins rate ( overall : 27 % , P = .012 ; pT2 : 20 % , P = .02 ) . With a mean follow-up of 38 months , obesity was not an independent predictive factor of biochemical recurrence . At the 12-month follow-up , 85 % , 74 % , and 72 % of normal , overweight , and obese men , respectively , were continent ( no pad ) ( P = .04 ) . At the 12-month follow-up , 57 % , 58 % , and 40 % of normal , overweight , and obese men , respectively , reported an erection sufficient for intercourse ( P = .01 ) . CONCLUSION Laparoscopic radical prostatectomy is a safe and effective procedure in obese men with midterm cancer control . However , obese patients are at higher risk of aggressive disease . Recovery of continence and potency in these patients are significantly lower compared to nonobese men Output:

The findings from meta- analysis showed that excess BMI was positively correlated with BCR of PCa multifacetedly , indicating good weight control and detailed attention to treating obese patients might improve the prognosis of PCa

MS2_1shot437

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: PURPOSE To evaluate the efficacy and toxicity of weekly paclitaxel and gemcitabine in patients with advanced transitional-cell carcinoma ( TCC ) of the urothelial tract . PATIENTS AND METHODS Patients with advanced unresectable TCC were enrolled onto this multicenter , community-based , phase II trial . Initially , patients were treated with paclitaxel 110 mg/m(2 ) and gemcitabine 1,000 mg/m(2 ) by intravenous infusion on days 1 , 8 , and 15 every 28 days . Patients who had an objective response or stable disease continued treatment for a maximum of six courses . Paclitaxel was decreased to 90 mg/m(2 ) and gemcitabine was decreased to 800 mg/m(2 ) for the last 12 patients because of a concerning incidence of pulmonary toxicity in the first 24 patients . RESULTS Thirty-six patients were enrolled between September 1998 and March 2003 . Twenty-four patients received the higher doses of paclitaxel and gemcitabine , and 12 patients received the lower doses . Twenty-five ( 69.4 % ) of 36 patients had major responses to treatment , including 15 patients ( 41.7 % ) with complete responses . With a median follow-up time of 38.7 months , the median survival time was 15.8 months . Grade 3 and 4 toxicities included granulocytopenia ( 36.1 % ) , thrombocytopenia ( 8.3 % ) , and neuropathy ( 16.7 % ) . Five patients ( 13.9 % ) had grade s 3 to 5 pulmonary toxicity , and one patient had grade 2 pulmonary toxicity . CONCLUSION Weekly paclitaxel and gemcitabine is an active regimen in the treatment of patients with advanced TCC . However , because of the high incidence of pulmonary toxicity associated with this schedule of paclitaxel and gemcitabine , we recommend against the use of this regimen in this patient population Transitional cell carcinomas may arise at any site within the urinary tract and are a source of considerable morbidity and mortality . In particular , patients with metastatic disease have a poor prognosis , with less than 5 % alive at 5 years . A multicentre r and omized trial comparing methotrexate and vinblastine ( MV ) with cisplatin , methotrexate and vinblastine ( CMV ) in advanced or metastatic transitional cell carcinoma was conducted in the UK . From April 1991 to June 1995 , 214 patients were entered by 16 centres , 108 r and omized to CMV and 106 to MV . A total of 204 patients have died . The hazard ratio ( relative risk of dying ) was 0.68 ( 95 % CI 0.51 - 0.90 , P-value = 0.0065 ) in favour of CMV . This translates to an absolute improvement in 1-year survival of 13 % , 16 % in MV and 29 % in CMV . The median survival for CMV and MV was 7 months and 4.5 months respectively . Two hundred and eight patients objective ly progressed or died . The hazard ratio was 0.55 ( 95 % CI 0.41 - 0.73 , P-value = 0.0001 ) in favour of CMV . Two hundred and nine patients symptomatically progressed or died . The hazard ratio was 0.48 ( 95 % CI 0.36 - 0.64 , P-value = 0.0001 ) in favour of CMV . The most important pretreatment factors influencing overall survival were WHO performance status and extent of disease . These two factors were used to derive a prognostic index which could be used to categorize patients into three prognostic groups . We conclude that the addition of cisplatin to methotrexate and vinblastine should be considered in patients with transitional cell carcinoma , taking into account the increased toxicity PURPOSE To assess the efficacy and toxicity of single-agent paclitaxel as first-line chemotherapy in patients with locally advanced or metastatic transitional-cell carcinoma of the urothelium . PATIENTS AND METHODS Twenty-six eligible patients were enrolled onto this cooperative group study and treated with paclitaxel at a dosage of 250 mg/m2 by 24-hour continuous infusion every 21 days until progression or patient intolerance . All patients received recombinant human granulocyte colony-stimulating factor ( rhG-CSF ) at 5 micrograms/kg/d for at least 10 days during each cycle . RESULTS Eleven of 26 patients ( 42 % ; 95 % confidence interval [ CI ] , 23 % to 63 % ) demonstrated an objective response , with seven achieving a complete clinical response ( CR ) ( 27 % ; 95 % CI , 12 % to 48 % ) and four ( 15 % ) a partial response ( PR ) . The median duration of response in the 11 responders is 7 + months ( range , 4 to 17 ) , with five responders ( four CRs , one PR ) remaining progression-free at 5 , 6 , 10 , 12 , and 16 months from the start of therapy . The estimated median survival duration for all patients is 8.4 months . Hematologic toxicity consisted of anemia ( 12 % grade 3 ) and granulocytopenia ( 4 % grade 3 , 19 % grade 4 ) , with two patients developing granulocytopenic fevers . Nonhematologic toxicity included grade 3 mucositis in 11 % , grade 3 neuropathy in 11 % , and grade 4 diarrhea in 4 % . CONCLUSION Single-agent paclitaxel at this dosage and schedule is one of the most active single agents in previously untreated patients with advanced urothelial carcinoma , and is well tolerated by this patient population when given with hematopoetic growth factor support PURPOSE To evaluate the toxicity and efficacy of combination chemotherapy with paclitaxel and gemcitabine in patients with advanced transitional-cell carcinoma of the urothelial tract . PATIENTS AND METHODS Fifty-four patients with advanced unresectable urothelial carcinoma entered this multi-centered , community-based , phase II trial between May 1997 and December 1999 . All patients were treated with paclitaxel 200 mg/m(2 ) by 1-hour intravenous ( IV ) infusion on day 1 and gemcitabine 1,000 mg/m(2 ) IV on days 1 , 8 , and 15 ; courses were repeated every 21 days . Patients who had objective response or stable disease continued treatment for six courses . RESULTS Twenty-nine of 54 patients ( 54 % ; 95 % confidence interval , 40 % to 67 % ) had major responses to treatment , including 7 % complete responses . With a median follow-up of 24 months , 16 patients ( 30 % ) remain alive and nine ( 17 % ) are progression-free . The median survival for the entire group was 14.4 months ; 1- and 2-year actuarial survival rates were 57 % and 25 % , respectively . Seven ( 47 % ) of 15 patients previously treated with platinum-based chemotherapy responded to paclitaxel/gemcitabine . Grade 3/4 toxicity was primarily hematologic , including leukopenia ( 46 % ) , thrombocytopenia ( 13 % ) , and anemia ( 28 % ) . Ten patients ( 19 % ) required hospitalization for neutropenia and fever , and one patient had treatment-related septic death . CONCLUSION The combination of paclitaxel and gemcitabine is active and well tolerated in the first- or second-line treatment of patients with advanced transitional-cell carcinoma of the urothelial tract . Response rate and duration compare favorably with those produced by other active , first-line regimens . This regimen should be further evaluated in phase II and III studies , as well as in patients with compromised renal function The carboplatin‐based chemotherapeutic regimen M‐CAVI ( methotrexate , carboplatin , and vinblastine ) is active against bladder carcinoma and can be administered to patients who are ineligible to receive cisplatin or doxorubicin . The authors design ed a r and omized study to evaluate whether M‐CAVI offers a therapeutic advantage over the cisplatin‐based regimen M‐VAC ( methotrexate , vinblastine , doxorubicin , and cisplatin ) in the treatment of patients with surgically incurable advanced bladder carcinoma Output:

Advanced bladder cancer is one tumor type in which EBM principles can be applied to determine the best treatment option

MS2_1shot438

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: OBJECTIVE To determine perioperative morbidity , survival , and local failure rates in a large group of consecutive patients with rectal cancer undergoing low anterior resection by multiple surgeons on a specialty service . The primary objective was to assess the surgical complications associated with preoperative radiation sequencing . SUMMARY BACKGROUND DATA The goals in the treatment of rectal cancer are cure , local control , and preservation of sphincter , sexual , and bladder function . Surgical resection using sharp perimesorectal dissection is important for achieving these goals . The complications and mortality rate of this surgical strategy , particularly in the setting of preoperative chemoradiation , have not been well defined . METHODS There were 1233 patients with primary rectal cancer treated at the authors ' cancer center from 1987 to 1995 . Of these , 681 underwent low anterior resection and /or coloanal anastomosis for primary rectal cancer . The surgical technique used the principles of sharp perimesorectal excision . Morbidity and mortality rates were compared between patients receiving preoperative chemoradiation ( Preop RT , n = 150 ) and those not receiving preoperative chemoradiation ( No Preop RT , n = 531 ) . Recurrence and survival data were determined in patients undergoing curative resection ( n = 583 , 86 % ) among three groups of patients : those receiving Preop RT ( n = 131 ) , those receiving postoperative chemoradiation ( Postop RT , n = 110 ) , and those receiving no radiation therapy ( No RT , n = 342 ) . RESULTS The perioperative mortality rate was 0.6 % ( 4/681 ) . Postoperative complications occurred in 22 % ( 153/681 ) . The operative time , estimated blood loss , and rate of pelvic abscess formation without associated leak were higher in the Preop RT group than the No Preop RT group . However , the overall complication rate , rate of wound infection , anastomotic leak , and length of hospital stay were no different between Preop RT and No Preop RT patients . With a median follow-up of 45.6 months , the overall actuarial 5-year recurrence rate for patients undergoing curative resection ( n = 583 ) was 19 % , with 4 % having local recurrence only , 12 % having distant recurrence , and 3 % having both local and distant recurrence , for an overall local recurrence rate of 7 % . The actuarial 5-year overall survival rate was 81 % ; the disease-free survival rate was 75 % and the local recurrence rate was 10 % . The overall survival rate was similar between Preop RT ( 85 % ) , Postop RT ( 72 % ) , and No RT ( 83 % ) patients ( p = 0.10 ) , whereas the disease-free survival rate was significantly worse for Postop RT ( 65 % ) patients compared with Preop RT ( 79 % ) and No RT ( 77 % ) patients ( p = 0.04 ) . CONCLUSION The use of preoperative chemoradiation results in increased operative time , blood loss , and pelvic abscess formation but does not increase the rate of anastomotic leaks or the length of hospital stay after low anterior resection for rectal cancer . The 5-year actuarial overall survival rate for patients undergoing curative resection exceeded 80 % , with a local recurrence rate of 10 % Aim The st and ard treatment for patients with clinical ly resectable rectal cancer is surgery . Postoperative radiochemotherapy ( RCT ) is recommended for advanced disease ( pT3/4 or pN+ ) . In recent years , encouraging results of pre‐operative radiotherapy have been reported . This prospect i ve r and omized phase‐III‐trial ( CAO/ARO/AIO‐94 ) compares the efficacy of neoadjuvant RCT to st and ard postoperative RCT . We report on the design of the study and first results with regard to toxicity of RCT and postoperative morbidity Introduction Total mesorectal excision ( TME ) with preoperative chemoradiation therapy is an accepted st and ard treatment for low rectal cancer . Although the laparoscopic approach is accepted for the treatment of colon cancer , its value for low rectal cancer is unknown . The purpose of this study was to evaluate whether preoperative chemoradiation therapy exerted an adverse influence on laparoscopic TME for low rectal cancer . Methods We studied 125 consecutive patients who underwent laparoscopic TME for low rectal cancer . Twenty patients with preoperative chemoradiation therapy ( CRT-Lap group ) were compared with 105 patients without chemoradiation therapy ( non-CRT-Lap group ) . Results Operating time in the CRT-Lap group ( 276 min , range 160–390 min ) was no different from that in the non-CRT-Lap group ( 263 min , range 143–456 min ) . The CRT-Lap group had more blood loss during the operation ( 70 vs. 37 ml ) , but mean blood loss was < 100 ml . The distal tumor margin was longer in the CRT-Lap group ( 25.8 vs. 18.6 mm ) . The number of lymph node harvested did not differ between the groups ( 14.5 vs. 15.4 ) . Conversion to open surgery was necessary only in one case in the non-CRT-Lap group . There was no anastomotic leakage in the CRT-Lap group , whereas three patients ( 3.1 % ) had anastomotic leakage in the non-CRT-Lap group . Conclusion Laparoscopic TME with preoperative chemoradiation therapy is a safe procedure with reasonable operating time and does not appear to pose any threat to the surgical and oncologic outcomes Summary Background Preoperative or postoperative radiotherapy reduces the risk of local recurrence in patients with operable rectal cancer . However , improvements in surgery and histopathological assessment mean that the role of radiotherapy needs to be reassessed . We compared short-course preoperative radiotherapy versus initial surgery with selective postoperative chemoradiotherapy . Methods We undertook a r and omised trial in 80 centres in four countries . 1350 patients with operable adenocarcinoma of the rectum were r and omly assigned , by a minimisation procedure , to short-course preoperative radiotherapy ( 25 Gy in five fractions ; n=674 ) or to initial surgery with selective postoperative chemoradiotherapy ( 45 Gy in 25 fractions with concurrent 5-fluorouracil ) restricted to patients with involvement of the circumferential resection margin ( n=676 ) . The primary outcome measure was local recurrence . Analysis was by intention to treat . This study is registered , number IS RCT N 28785842 . Findings At the time of analysis , which included all participants , 330 patients had died ( 157 preoperative radiotherapy group vs 173 selective postoperative chemoradiotherapy ) , and median follow-up of surviving patients was 4 years . 99 patients had developed local recurrence ( 27 preoperative radiotherapy vs 72 selective postoperative chemoradiotherapy ) . We noted a reduction of 61 % in the relative risk of local recurrence for patients receiving preoperative radiotherapy ( hazard ratio [ HR ] 0·39 , 95 % CI 0·27–0·58 , p<0·0001 ) , and an absolute difference at 3 years of 6·2 % ( 95 % CI 5·3–7·1 ) ( 4·4 % preoperative radiotherapy vs 10·6 % selective postoperative chemoradiotherapy ) . We recorded a relative improvement in disease-free survival of 24 % for patients receiving preoperative radiotherapy ( HR 0·76 , 95 % CI 0·62–0·94 , p=0·013 ) , and an absolute difference at 3 years of 6·0 % ( 95 % CI 5·3–6·8 ) ( 77·5 % vs 71·5 % ) . Overall survival did not differ between the groups ( HR 0·91 , 95 % CI 0·73–1·13 , p=0·40 ) . Interpretation Taken with results from other r and omised trials , our findings provide convincing and consistent evidence that short-course preoperative radiotherapy is an effective treatment for patients with operable rectal cancer . Funding Medical Research Council ( UK ) and the National Cancer Institute of Canada BACKGROUND In many patients with rectal cancer , defunctioning stomas are created to limit the consequences of anastomotic leakage . Although intended to be temporary , a substantial proportion of these stomas might never be reversed for various reasons . We aim ed to describe stoma policy by use of data from the total mesorectal excision ( TME ) trial in patients with rectal cancer and to identify factors that limit stoma reversal . METHODS 924 Dutch patients with rectal cancer who underwent a low anterior resection were selected from the TME trial , a prospect i ve , r and omised multicentre trial study ing the effects of short-term preoperative radiotherapy in 1861 patients who underwent TME . Creation of stomas and time to stoma reversal were analysed retrospectively by use of multivariate analysis . FINDINGS In 523 of 924 ( 57 % ) patients , a primary stoma ( defined as a stoma created at the time of TME ) was constructed after a low anterior resection . Geographical differences in the number of primary stomas constructed were reported throughout the Netherl and s. 19 % of stomas that were created were never reversed . Postoperative complications and secondary constructed stomas ( defined as a stoma created during a second or subsequent procedure after TME ) were associated with a high likelihood of a permanent stoma . However , perioperative complications were not a limiting factor for stoma closure . INTERPRETATION Postoperative complications are an important limiting factor for stoma reversal because , after occurrence of these complications , patients and surgeons might be reluctant to reverse the stoma , so a substantial proportion of these stomas are never closed . Future guidelines for stoma creation and closure should consider these factors BACKGROUND We and others have shown that angiogenesis and leukocyte infiltration are important prognostic factors in rectal cancer . However , little is known about its possible changes in response to radiotherapy ( RTX ) , which is frequently given to rectal tumors as a neoadjuvant treatment to improve the prognosis . We therefore investigated the biologic effects of RTX on these parameters using fresh-frozen biopsy sample s of tumor and normal mucosa tissue before and after RTX . METHODS Biopsy sample s were taken from a total of 34 patients before and after either a short course or long course of RTX combined with chemotherapy . The following parameters were analyzed by immunohistochemistry , flow cytometry , or quantitative real-time polymerase chain reaction : Microvessel density , leukocyte infiltration , proliferating epithelial and tumor cells , proliferating endothelial cells , adhesion molecule expression on endothelial cells , and the angiogenic mRNA profile . RESULTS The tumor biopsy sample s taken after RTX treatment demonstrated a significant decrease in microvessel density and the number of proliferating tumor cells and proliferating endothelial cells ( p < 0.001 ) . In contrast , the leukocyte infiltration , the levels of basic fibroblast growth factor in carcinoma tissue , and the adhesion molecule expression on endothelial cells in normal as well as carcinoma tissue increased significantly ( p < 0.05 ) . CONCLUSION Our data show that together with an overall decrease in tumor cell and endothelial cell proliferation , RTX results in an increase in the expression of adhesion molecules that stimulate leukocyte infiltration . This suggests the possibility that , in addition to its direct cytotoxic effect , radiation may also stimulate an immunologic tumor response that could contribute to the documented improvement in local tumor control and distal failure rate of rectal cancers Although many trials have shown the efficacy of preoperative chemoradiotherapy ( CRT ) or postoperative CRT compared with surgery alone , the optimal sequence of radiotherapy and surgery is unclear . The authors reported the final results of this single institution prospect i ve r and omized phase 3 trial comparing preoperative CRT with postoperative CRT using capecitabine in survival , local control , sphincter preservation , and toxicity for the treatment of locally advanced rectal cancer Purpose This study was undertaken to determine whether neoadjuvant radiotherapy is associated with an increased risk of anastomotic leak for rectal cancer patients undergoing restorative resection . Methods From 1980 to 2010 , patients who underwent restorative resection for rectal cancer ( tumors within 15 cm of anal verge ) were identified from a prospect i ve institutional data base and grouped based on whether they received neoadjuvant radiotherapy ( + RT ) or not ( −RT ) . The main outcome was anastomotic leak documented by imaging ( contrast leak ) , intra-operative or clinical ( signs of peritonitis ) findings and confirmed by staff surgeon assessment . Using multivariate ( MV ) analysis risk factors for leak were identified , presented as OR ( 95 % CI ) . Results One thous and eight hundred sixty-two patients were included in the analysis , 28 % in the + RT group . Eighty-six percent of + RT patients received neoadjuvant chemoradiotherapy . The overall leak rate was 6.3 % , with no significant difference in + RT and −RT groups ( 8 % vs 5.7 % , p = 0.06 ) . The + RT group had a lower mean age at surgery ( 58 vs 63 year , p < 0.001 ) Output:

The interval to surgery after neoadjuvant therapy and preoperative radiotherapy ( short or long course ) was not associated with an increased incidence of postoperative AL . Conclusion Neoadjuvant therapy does not appear to increase the incidence of postoperative AL after anterior resection for mid and low rectal cancer . In addition , neither the interval to surgery after neoadjuvant therapy nor the radiotherapy regimen increases the rate of postoperative AL

MS2_1shot439

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Background Clinical h and over is a necessary process for the continuation of safe patient care ; however , deficiencies in the h and over process can introduce error . While the number of h and over studies increases , few have vali date d implemented improvements with repeated audit . Objective To improve the morning h and over round on a busy critical care unit and assess sustainability of improvement through repeated audit . Design / Methods A quality improvement process based on prospect i ve observational assessment of the doctor 's shift-change h and over was carried out , assessing the content of clinical information and effects of distractions , location and timing . The effect of a training session for the junior doctors with the introduction of a st and ardised h and over protocol was assessed . Results The content of clinical information improved after the training session with introduction of a st and ardised protocol , but returned to baseline with a new cohort of untrained doctors . Distractions were associated with increased h and over times for individual patients and for total h and over time . Overall , h and over time was shortest in the coffee room compared with ward and lecture theatre h and overs . Individual patient h and over time was positively correlated with clinical content scores . Four indices of critical illness all positively correlated with increased h and over time . Conclusions Early specific training is vital for quality clinical h and over . Distractions during h and over cause inefficiency and can adversely affect information transfer . Changing h and over location according to local environment can yield improved efficiency , structure and ease of management . Adequate time must be allocated for clinical h and over especially when dealing with very sick and complex patients A critical care clinical pharmacy specialist was assigned to the burn center to make scheduled rounds with the physicians and to attend the weekly multidisciplinary burn team rounds . A prospect i ve 6-month study was completed to 1 ) determine the clinical impact of the pharmacist 's interventions and 2 ) quantify cost savings generated by these interventions . Prospect i ve data concerning clinical interventions by the pharmacist were collected during a 6-month period . Each intervention was independently review ed by two attending burn surgeons to determine its importance . A total of 165 interventions in 76 patients were documented . Following an independent review of each intervention by burn surgery attendings , 121 of 165 interventions were felt to have improved overall patient care , 42 of 165 prevented possible drug-related toxicity or organ dysfunction , 1 of 165 prevented a possible life-threatening event , and only 1 of 165 was considered insignificant . Drug changes suggested by the pharmacist result ed in a savings of $ 11,081.14 for the 6-month period . The integration of the critical care pharmacist into clinical rounds results in significant cost avoidance and improves overall patient care CONTEXT Pharmacist review of medication orders in the intensive care unit ( ICU ) has been shown to prevent errors , and pharmacist consultation has reduced drug costs . However , whether pharmacist participation in the ICU at the time of drug prescribing reduces adverse events has not been studied . OBJECTIVE To measure the effect of pharmacist participation on medical rounds in the ICU on the rate of preventable adverse drug events ( ADEs ) caused by ordering errors . DESIGN Before-after comparison between phase 1 ( baseline ) and phase 2 ( after intervention implemented ) and phase 2 comparison with a control unit that did not receive the intervention . SETTING A medical ICU ( study unit ) and a coronary care unit ( control unit ) in a large urban teaching hospital . PATIENTS Seventy-five patients r and omly selected from each of 3 groups : all admissions to the study unit from February 1 , 1993 , through July 31 , 1993 ( baseline ) and all admissions to the study unit ( postintervention ) and control unit from October 1 , 1994 , through July 7 , 1995 . In addition , 50 patients were selected at r and om from the control unit during the baseline period . INTERVENTION A senior pharmacist made rounds with the ICU team and remained in the ICU for consultation in the morning , and was available on call throughout the day . MAIN OUTCOME MEASURES Preventable ADEs due to ordering ( prescribing ) errors and the number , type , and acceptance of interventions made by the pharmacist . Preventable ADEs were identified by review of medical records of the r and omly selected patients during both preintervention and postintervention phases . Pharmacists recorded all recommendations , which were then analyzed by type and acceptance . RESULTS The rate of preventable ordering ADEs decreased by 66 % from 10.4 per 1000 patient-days ( 95 % confidence interval [ CI ] , 7 - 14 ) before the intervention to 3.5 ( 95 % CI , 1 - 5 ; P<.001 ) after the intervention . In the control unit , the rate was essentially unchanged during the same time periods : 10.9 ( 95 % CI , 6 - 16 ) and 12.4 ( 95 % CI , 8 - 17 ) per 1000 patient-days . The pharmacist made 366 recommendations related to drug ordering , of which 362 ( 99 % ) were accepted by physicians . CONCLUSIONS The presence of a pharmacist on rounds as a full member of the patient care team in a medical ICU was associated with a substantially lower rate of ADEs caused by prescribing errors . Nearly all the changes were readily accepted by physicians OBJECTIVE To evaluate the clinical pharmacists ' interventions in an intensive care unit ( ICU ) setting with regard to their acceptance by the medical team , frequency , clinical significance , and targeted patient 's outcomes . METHODS This is a prospect i ve , non-comparative , observational study evaluating the clinical pharmacist interventions in an ICU setting from December 2002 to May 2003 . The study was conducted in a 19-bed Cardiac-Surgery ICU at King Faisal Specialist Hospital & Research Center , a tertiary-care hospital in Riyadh , Saudi Arabia . The clinical pharmacist performed daily multi-disciplinary team rounds , with documentation of all his interventions . On the same day , a physician , who is a part of the team , verified all interventions for validity and clinical significance . The institutional Office of Research Affairs approved the study . RESULTS The clinical pharmacist intervened 394 times on the 600 patients [ 0.66 intervention-per-patient ] . The medical team accepted almost all interventions ( 94.3 % ) . The main drug-related problems were the following : no drug prescribed for medical condition ( 33.2 % ) , inappropriate dosing regimen ( 28.9 % ) , and no indication for drug use ( 14.3 % ) . Approximately 55.7 % of the interventions targeted enhancing therapeutic outcomes , whilst 21.8 % of interventions result ed in the prevention of an adverse drug reaction . The interventions that may have result ed in decreasing mortality , preventing , or reducing organ damage , or decreasing hospitalization , represented 8.1 % of all interventions . CONCLUSION Participation of a clinical pharmacist in the daily multidisciplinary team rounds in an ICU setting significantly reduces unfavorable morbidities and enhances therapeutic outcomes We prospect ively studied the relationship between interdisciplinary collaboration and patient outcomes in the medical intensive care unit ( MICU ) using nurses ' and residents ' reports of amount of collaboration involved in making decisions about transferring patients from the MICU to a unit with a less intense level of care . Either readmission to the MICU or death was considered a negative patient outcome . Nurses ' reports of collaboration were significantly ( p = 0.02 ) and positively associated with patient outcome , controlling for severity of illness . Patient predicted risk of negative outcome decreased from 16 % , when the nurse reported no collaboration in decision making , to 5 % when the process was fully collaborative . There was an interaction of collaboration with availability of alternative choices in the transfer decision-making situation . When alternatives were available , collaboration was more strongly associated with patient outcome . There was no significant relationship between residents ' reports of collaboration and patient outcomes . The correlation between amount of collaboration reported by nurses and residents about the same decisions was quite low ( r = 0.10 ) BACKGROUND The Joint Commission on the Accreditation of Healthcare Organizations reports that communication breakdowns are responsible for 85 % of sentinel events in hospitals . Patients in surgical ICUs are the most vulnerable to communication errors . Fellows and residents are an integral part of the surgical ICU team , but little is known about resident-fellow communication and its impact on surgical ICU patient outcomes . The objective of this study is to describe resident-fellow patient care communication patterns in the surgical ICU and correlate established communication patterns with short-term outcomes . STUDY DESIGN A prospect i ve observational trial was conducted for 136 consecutive surgical ICU days . We evaluated resident-fellow communication of four cardiorespiratory events : hypotension , new arrhythmias , tachypnea , and desaturation . We prospect ively defined three short-term outcomes : improved , not improved , and worse . An intervention was attempted to improve communication . RESULTS Three hundred twelve events were collected ( 166 observational and 146 interventional ) . PGY3 residents covered approximately 60 % of days in both phases . PGY3 residents were responsible for 73 % of communication errors in the observational phase and 59 % of communication errors in the interventional phase . Communication errors were more likely in the late shift ( p < 0.0001 ) . The late shift was responsible for 77 % of all communication errors . Communication errors result ed in worse short-term outcomes for cardiorespiratory events ( p < 0.0002 ) . Effective communication was a significant predictor of improved short-term outcomes ( p < 0.0003 ) . The intervention decreased communication errors in the late shift by 10 % ( p < 0.052 ) . CONCLUSIONS Communication errors occurred more frequently during the late shift . These communication errors were associated with worsened short-term outcomes . Improved communication in the surgical ICU is a fruitful target to improve clinical outcomes Objective : To improve communication during daily rounds using sequential interventions . Design : Prospect i ve cohort study . Setting : Multidisciplinary pediatric intensive care unit in a university hospital . Subjects : The multidisciplinary rounding team in the pediatric intensive care unit , including attending physicians , physician trainees , and nurses . Interventions : Daily rounds on 736 patients were observed over a 9-month period . Sequential interventions were timed 8–12 wks apart : 1 ) implementing a new resident daily progress note format ; 2 ) creating a performance improvement “ dashboard ” ; and 3 ) documenting patients ' daily goals on bedside whiteboards . Measurements and Main Results : After all interventions , team agreement with the attending physician 's stated daily goals increased from 56.9 % to 82.7 % ( p < .0001 ) . Mean agreement increased for each provider category : 65.2 % to 88.8 % for fellows ( p < .0001 ) , 55.0 % to 83.8 % for residents ( p < .0001 ) , and 54.1 % to 77.4 % for nurses ( p < .0001 ) . In addition , significant improvements were noted in provider behaviors after interventions . Barriers to communication ( bedside nurse multitasking during rounds , interruptions during patient presentations , and group disassociation ) were reduced , and the use of communication facilitators ( review of the prior day 's goals , inclusion of bedside nurse input , and order read-back ) increased . The percentage of providers reporting being “ very satisfied ” or “ satisfied ” with rounds increased from 42.6 % to 78.3 % ( p < .0001 ) . Conclusions : Shared agreement of patients ' daily goals among key healthcare providers can be increased through process-oriented interventions . Improved agreement will potentially lead to improved quality of patient care and reduced medical errors BACKGROUND The incidence of ventilator-associated pneumonia ( VAP ) in trauma patients can be decreased with use of the ventilator bundle ( VAPB ) . Our VAP rate remained high despite the adoption of the VAPB . To better implement the VAPB , a multidisciplinary team composed of the surgical intensive care unit ( SICU ) nursing staff , physician , and respiratory therapist review ed briefly a checklist of VAPB goals for each patient before morning attending rounds . We hypothesized that such daily goal rounds ( GR ) focused on the VAPB would decrease the VAP rate . METHODS A pre-GR ten-month period ( November 2006 to August 2007 ) was compared with the ten-month period ( September 2007 to June 2008 ) with daily GRs . The occurrence of VAPs was tallied prospect ively in all intubated trauma patients using the National Nosocomial Infection Surveillance criteria . Patient characteristics and outcome data were obtained from our trauma registry and medical records . Patient characteristics were similar in the 85 pre-GR patients and the 89 GR patients . RESULTS The number of VAPs decreased 67 % in the GR patients ( 15 pre-GR vs. 5 GR ; p=0.02 ) ; however , the all-cause mortality rate remained similar ( 16.5 % vs. 21.3 % ; p=0.41 ) . When patients were divided into those with and without VAP , there was a significant increase in mean ventilator , SICU , and hospital days in patients with VAP ( p=0.01 for all ) . There were only two deaths among trauma patients with VAP . CONCLUSION Daily multidisciplinary GRs focused on the VAPB can decrease the incidence of VAP significantly in trauma patients . Ventilator- Output:

Identified facilitators suggest that the quality of rounds is improved when conducted by a multidisciplinary group of providers , with explicitly defined roles , using a st and ardized structure and goal -oriented approach that includes a best practice s checklist . Barriers to quality patient care rounds include poor information retrieval and documentation , interruptions , long rounding times , and allied healthcare provider perceptions of not being valued by rounding physicians .

MS2_1shot440

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background and objective : Sore throat and hoarseness rank , besides pain and nausea , among the most frequent subjective complaints after tracheal intubation for general anaesthesia . Our intention was to determine the incidence of postoperative sore throat from a large sample of patients and thus to identify the most important associated factors . Methods : We prospect ively followed up 809 adult patients who underwent elective surgical interventions and examined their history , the applied anaesthetic techniques , perioperative course and the occurrence , intensity and duration of postoperative throat complaints . The assignment and professional experience of the involved intubators were also assessed . The influence of a multitude of variables on postoperative throat complaints was statistically analysed . Results : Postoperative sore throat was present in 40 % overall being significantly higher in female than in male ( 44 % vs. 33 % ; P = 0.001 ) . The mean pain intensity in the affected patients ( n = 323 ) was 28 ± 12 mm on a visual analogue scale where 0 = no pain and 100 = extreme pain . The average duration was 16 ± 11 h. Main factors associated with throat complaints were female sex , history of smoking or lung disease , duration of anaesthesia , postoperative nausea , bloodstain on the endotracheal tube and natural teeth . We could find no influence on the occurrence or intensity of throat complaints by the professional assignment or the length of professional experience of the personnel involved . Conclusions : Postoperative throat complaints frequently arise after tracheal intubation for general anaesthesia in the first 2 postoperative days , but they are of limited intensity and duration Background and Aims : Postoperative sore throat ( POST ) is a well-recognized complication after general anesthesia ( GA ) . Numerous nonpharmacological and pharmacological measures have been used for attenuating POST with variable success . The present study was conducted to compare the efficiency of preoperative nebulization of normal saline and magnesium sulfate in reducing the incidence of POST following GA . Material s and Methods : Following institutional ethical committee approval and written informed consent , a prospect i ve r and omized double-blinded study was conducted in 100 cases divided into two equal groups . Patients included in the study were of either gender belonging to American Society of Anesthesiologist ( ASA ) status 1 or 2 undergoing elective surgery of approximately 2 h or more duration requiring tracheal intubation . Patients in Group A are nebulized with 3 ml of normal saline and the patients in Group B are nebulized with 3 ml of 225 mg isotonic nebulized magnesium sulfate for 15 min , 5 min before induction of anesthesia . The incidence of POST at rest and on swallowing and any undue complaints at 0 , 2 , 4 , and 24 h in the postoperative period are evaluated . Results : There is no significant difference in POST at rest during 0th , 2nd and 4th h between normal saline and MgSO4 . Significant difference is seen at 24th h , where MgSO4 lessens POST . There is no significant difference in POST on swallowing during 0th and 2nd h between normal saline and MgSO4 . Significant difference is seen at 4th h , where MgSO4 has been shown to lessen POST . Conclusions : MgSO4 significantly reduces the incidence of POST compared to normal saline BACKGROUND Postoperative sore throat is a common complication of anaesthesia and can lead to dissatisfaction after surgery . Many factors can contribute to postoperative sore throat and the incidence varies with the method of airway management . METHODS In this prospect i ve observational study elective gynaecological and general surgical patients were interviewed 24 hours postoperatively to determine the presence of sore throat . Information collected included demographic data , surgical procedure , duration of surgery , airway device used and position of patient during surgery . This study was done over a period of 3 months . RESULTS 312 patients were interviewed . 81(26 % ) patients suffered with sore throat postoperatively . 28 % of patients with endotracheal intubation ( ETT ) and 3.5 % of patients with laryngeal mask airway had a sore throat . Female patients reported more sore throat than male patients ( 27.1 % vs. 19.1 % ) . Sore throat was found to be more common with older age group , grade of difficulty in intubation , duration of surgery and patient 's position during surgery . CONCLUSION Awareness of the factors responsible for increased incidence of postoperative sore throat and appropriate care especially during endotracheal intubation can help to reduce the incidence of postoperative sore throat BACKGROUND Postoperative sore throat ( POST ) has been one of the most common complaints after anesthesia . In Siriraj Hospital , a high volume of general anesthesia is performed annually , but there was limited data regarding this complaint . OBJECTIVE To describe the incidence of POST and to determine risk factors associated with the occurrence of POST MATERIAL AND METHOD : Three hundred eighty seven patients were prospect ively studied . Demographic data , airway management , and intra-operative data were recorded . Sore throat occurrence and its intensity at postoperative 24 hours as well as patient satisfaction were assessed . RESULTS The overall incidence of POST was 35.7 % ( 95 % confidence interval [ CI ] 30.9 - 40 . 7 % ) with the mean intensity of 29.8 + /- 21.2 . Operation of the neck was found to be an independent risk factor of 24-hour POST ( odds ration [ OR ] 3.43 , 95 % confidence interval [ CI ] 1.88 - 6.25 , p < 0.001 ) , whereas in gynecological surgery the occurrence was significantly attenuated ( OR 0.49 , 95 % CI 0.26 - 0.95 , p = 0.035 ) . CONCLUSION POST was common after general anesthesia . Careful airway management might be the key to prevent this occurrence and to improve the quality of anesthetic care Background Diffusion of nitrous oxide into the cuff of the endotracheal tube results in an increase in cuff pressure . Excessive endotracheal tube cuff pressure may impair tracheal mucosal perfusion and cause tracheal damage and sore throat . Filling the cuff of the endotracheal tube with saline instead of air prevents the increase in cuff pressure due to nitrous oxide diffusion . This method was used to test whether tracheal morbidity is related to excess in tracheal cuff pressure during balanced anesthesia . Methods Fifty patients with American Society of Anesthesiologists physical status I or II were r and omly allocated to two groups with endotracheal tube cuffs initially inflated to 20–30 cm H2O with either air ( group A ) or saline ( group S ) . Anesthesia was maintained with isoflurane and nitrous oxide . At the time of extubation , a fiberoptic examination of the trachea was performed by an independent observer , and abnormalities of tracheal mucosa at the level of the cuff contact area were scored . Patients assessed their symptoms ( sore throat , dysphagia , and hoarseness ) at the time of discharge from the postanesthesia care unit and 24 h after extubation on a 101-point numerical rating scale . Results Cuff pressure increased gradually during anesthesia in group A but remained stable in group S. The incidence of sore throat was greater in group A than in group S in the postanesthesia care unit ( 76 vs. 20 % ) and 24 h after extubation ( 42 vs. 12%;P < 0.05 ) . Tracheal lesions at time of extubation were seen in all patients of group A and in eight patients ( 32 % ) of group S ( P < 0.05 ) . Conclusion Excess in endotracheal tube cuff pressure during balanced anesthesia due to nitrous oxide diffusion into this closed gas space causes sore throat that is related to tracheal mucosal erosion Context : Postoperative sore throat ( POST ) is a complication that is unresolved in patients undergoing endotracheal intubation . Aim : To compare the effects of ketamine and magnesium sulfate nebulizations in two strengths , on the incidence and severity of POST , hoarseness , and cough . Setting s and Design : Sixty surgical patients undergoing elective abdominal and lower limb surgeries under combined epidural and general anesthesia were included in this prospect i ve , r and omized , double-blinded study . Subjects and Methods : Patients in each group were nebulized with the respective study drug 15 min prior to the surgery , i.e. , ketamine in Group K , magnesium sulfate 250 mg , and 500 mg in Group M1 and Group M2 , respectively , and normal saline as control in Group C. A st and ardized anesthesia protocol was followed for all patients . After extubation , the patients were asked to grade POST , hoarseness , and cough at 0 , 2 , 4 , 12 , and 24 h. Statistical Analysis Used : One-way analysis of variance , Chi-square test , Fisher 's exact test , paired t-tests , and Wilcoxon 's signed-rank test as applicable . Results : Ketamine and magnesium sulfate 500 mg demonstrated a statistically significant decrease in POST at 0 , 2 , and 4 h , and postoperative hoarseness at 0 h. There was decrease in the incidence and severity of sore throat , hoarseness , and cough at all periods in the study groups as compared with control . Conclusion : Nebulization with ketamine 50 mg and magnesium sulfate 500 mg , 15 min before induction of general anesthesia and intubation , reduce the incidence and severity of POST and hoarseness of voice BACKGROUND Sore throat is a common complication of anaesthesia that affects patient satisfaction after surgery . METHODS We studied 5264 ambulatory surgical patients prospect ively to determine the patient , anaesthetic , and surgical factors associated with sore throat . RESULTS In 5264 patients , 12.1 % reported a sore throat . Patients with tracheal tube had the greatest incidence , 45.4 % , followed by patients with laryngeal mask airway , 17.5 % , while patients with a facemask had a lower incidence of sore throat , 3.3 % . Female patients had more sore throats than male patients ( 13.4 vs 9.1 % ) . Airway management had the strongest influence on the incidence of sore throat . Sore throat in ambulatory surgical patients was associated with female sex , younger patients , use of succinylcholine , and gynaecological surgery . CONCLUSION Airway management , female sex , younger patients , surgery for gynaecological procedure , and succinylcholine predicts postoperative sore throat . Increased awareness of the predictive factors can help to avoid this combination and improve patient satisfaction BACKGROUND Sore throat and hoarseness are common complications , but these have not been studied after total i.v . anaesthesia . METHODS We prospect ively studied 418 surgical patients , aged 15 - 92 yr , after total i.v . anaesthesia with propofol , fentanyl and ketamine to assess possible factors associated with sore throat and hoarseness . RESULT We found sore throat in 50 % and hoarseness in 55 % of patients immediately after surgery . This decreased to 25 % for sore throat and 24 % for hoarseness on the day after surgery . Both sore throat and hoarseness were more common in females and when lidocaine spray had been used . Cricoid pressure during laryngoscopy was inversely associated with the risk of sore throat . CONCLUSION Knowledge of these factors may reduce postoperative throat complications , and improve patient satisfaction S ystematic review s are relied upon by clinicians and policymakers as high- quality evidence for decision-making . In some hierarchies of evidence quality , systematic review s are ranked at the top , higher than r and omized controlled trials . A properly conducted systematic review that is based on high- quality articles provides very strong evidence ; policymakers recognize this value and solicit many such review s. Busy clinicians rely on well-executed systematic review s to quickly synthesize the literature and guide them in managing patients . However , there are important inherent weaknesses that can limit the quality of systematic review s and can lead to erroneous conclusions . Consumers of systematic review s should approach them with a healthy sense of skepticism . Unfortunately , many of these weaknesses may not be obvious to the various stakeholders who routinely invest their trust in such review s. The first bias one encounters is inherent in the research enterprise . Generally , research ers design studies to demonstrate maximum effect ; hence they are careful about the population selected , the interventions tested , and the outcomes assessed . For example , interventions are often tested in population s that are at high risk for experiencing the outcome in question and are likely to respond to the intervention . Not only can this make results difficult to generalize , but it often results in studies that overstate the benefit ; subsequent studies frequently find less benefit . This is particularly common when the pool of available studies consists of small , single-center investigations , trials that are particularly likely to show large effects . While usually not intentional , the combination of careful selection of population and outcomes can Output:

The trial sequential analysis suggested that there is adequate evidence supporting the efficacy of topical magnesium in preventing postoperative sore throat . Conclusion Our study suggests that preoperative topical magnesium can effectively prevent postoperative sore throat . ConclusionS elon les résultats de notre étude , l’application préopératoire topique de magnésium est efficace pour prévenir les maux de gorge postopératoires .

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***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: HYPOTHESIS Laparoscopic anterior 90 degrees partial fundoplication for gastroesophageal reflux is associated with a lower incidence of postoperative dysphagia and other adverse effects compared with laparoscopic Nissen fundoplication . DESIGN A multicenter , prospect i ve , double-blind , r and omized controlled trial . SETTING Nine university teaching hospitals in 6 major cities in Australia and New Zeal and . PARTICIPANTS One hundred twelve patients with proven gastroesophageal reflux disease presenting for laparoscopic fundoplication were r and omized to undergo either a Nissen ( 52 patients ) or an anterior 90 degrees partial procedure ( 60 patients ) . Patients with esophageal motility disorders , patients requiring a concurrent abdominal procedure , and patients who had undergone previous antireflux surgery were excluded from this study . INTERVENTIONS Laparoscopic Nissen fundoplication with division of the short gastric vessels or laparoscopic anterior 90 degrees partial fundoplication . MAIN OUTCOME MEASURES Independent assessment of dysphagia , heartburn , and overall satisfaction 1 , 3 , and 6 months after surgery using multiple clinical grading systems . Objective measurement of esophageal manometric parameters , esophageal acid exposure , and endoscopic assessment . RESULTS Postoperative dysphagia , and wind-related adverse effects were less common after a laparoscopic anterior 90 degrees partial fundoplication . Relief of heartburn was better following laparoscopic Nissen fundoplication . Overall satisfaction was better after anterior 90 degrees partial fundoplication . Lower esophageal sphincter pressure , acid exposure , and endoscopy findings were similar for both procedures . CONCLUSIONS At the 6-month follow-up , laparoscopic anterior 90 degrees culine partial fundoplication is followed by fewer adverse effects than laparoscopic Nissen fundoplication with full fundal mobilization , and it achieves a higher rate of satisfaction with the overall outcome . However , this is offset to some extent by a greater likelihood of recurrent gastroesophageal reflux symptoms Objective To determine the influence of preoperative esophageal motility on clinical and objective outcome of the Toupet or Nissen fundoplication and to evaluate the success rate of these procedures . Summary background data Nissen fundoplication ( 360 ° ) is the st and ard operation in the surgical management of gastroesophageal reflux disease ( GERD ) . In order to avoid postoperative dysphagia it has been proposed to tailor antireflux surgery according to pre-existing esophageal motility . Postoperative dysphagia is thought to occur more commonly in patients with esophageal dysmotility and it has been recommended to use the Toupet procedure ( 270 ° ) in these patients . We performed a r and omized trial to evaluate this tailored concept and to compare the two operative techniques concerning reflux control and complication rate ( dysphagia ) . Methods 200 patients with GERD were included in a prospect i ve , r and omized study . After preoperative examinations ( clinical interview , endoscopy , 24-hour pH-metry and esophageal manometry ) 100 patients underwent either a laparoscopic Nissen procedure ( 50 with and 50 without motility disorders ) , or Toupet ( 50 with and 50 without motility disorders ) . Postoperative follow-up after two years included clinical interview , endoscopy , 24-hour pH-metry , and esophageal manometry . Results After two years 85 % ( Nissen ) and 85 % ( Toupet ) of patients were satisfied with the operative result . Dysphagia was more frequent following a Nissen fundoplication compared to Toupet ( 19 vs. 8 , p < 0.05 ) and did not correlate with preoperative motility . Concerning reflux control the Toupet proved to be as good as the Nissen procedure . Conclusion Tailoring antireflux surgery according to the esophageal motility is not indicated , as motility disorders are not correlated with postoperative dysphagia . The Toupet procedure is the better operation as it has a lower rate of dysphagia and is as good as the Nissen fundoplication in controlling reflux Background : With the introduction of laparoscopic antireflux surgery ( LARS ) for gastro-oesophageal reflux disease ( GORD ) along with the increasing efficacy of modern medical treatment , a direct comparison is warranted . The 3-year interim results of a r and omised study comparing both the efficacy and safety of LARS and esomeprazole ( ESO ) are reported . Methods : LOTUS is an open , parallel-group multicentre , r and omised and controlled trial conducted in dedicated centres in 11 European countries . LARS was completed according to a st and ardised protocol , comprising a total fundoplication and a crural repair . Medical treatment comprised ESO 20 mg once daily , which could be increased stepwise to 40 mg once daily and then 20 mg twice daily in the case of incomplete GORD control . The primary outcome variable was time to treatment failure ( Kaplan – Meier analysis ) . Treatment failure was defined on the basis of symptomatic relapse requiring treatment beyond that stated in the protocol . Results : 554 patients were r and omised , of whom 288 were allocated to LARS and 266 to ESO . The two study arms were well matched . The proportions of patients who remained in remission after 3 years were similar for the two therapies : 90 % of surgical patients compared with 93 % medically treated for the intention to treat population , p = 0.25 ( 90 % vs 95 % per protocol ) . No major unexpected postoperative complications were experienced and ESO was well tolerated . However , postfundoplication complaints remain a problem after LARS . Conclusions : Over the first 3 years of this long-term study , both laparoscopic total fundoplication and continuous ESO treatment were similarly effective and well-tolerated therapeutic strategies for providing effective control of GORD INTRODUCTION To evaluate the clinical outcomes of laparoscopic floppy Nissen fundoplication ( LNF ) and laparoscopic Toupet fundoplication ( LTF ) for the treatment of gastroesophageal disease ( GERD ) . METHODS A total of 84 patients with GERD were r and omized to either LNF ( n = 43 ) or LTF ( n = 41 ) between January 2010 and January 2013 . The primary endpoint measures were the DeMeester score , distal esophageal amplitude ( DEA ) , peristaltic frequency , lower esophageal sphincter pressure ( LESP ) , short-term and long-term postoperative dysphagia and recurrence rate . The secondary endpoints were improvements in symptom scores and quality of life ( QoL ) , and perioperative complications . RESULTS LNF group had a lower DeMeester score and a higher LESP compared to LTF group after surgery ( DeMeester score : P = 0.007 ; LESP : P = 0.027 ) . The mean DEA and peristaltic frequency both improved significantly after surgery in 2 groups . There was no difference in the incidence of short-term adverse events ( including dysphagia , heartburn , regurgitation et al. ) between the two groups ( P = 0.157 ) . At the time of the latest follow-up , there was no difference in the incidence of symptomatic reflux symptom ( heartburn and regurgitation ) between the two groups ( heartburn : P = 0.363 ; regurgitation : P = 1.000 ) . A higher frequency of dysphagia was present in the LNF group compared with the LTF group ( P = 0.023 ) . DISCUSSION LNF is associated with an excessive elevation of LESP which may lead to further persistent dysphagia . Partial fundoplication may provide adequate reflux control , improve esophageal body motility and minimize complications associated with an ' over-tight ' fundal wrap . CONCLUSION LTF seems to be as safe and effective on the long-term as LNF , but with a lower incidence of postoperative dysphagia ( ChiCTR-TRC-13003945 ) BACKGROUND Very few r and omized controlled trials ( RCTs ) have compared laparoscopic Nissen fundoplication ( LNF ) to proton pump inhibitors ( PPI ) medical management for patients with chronic gastroesophageal reflux disease ( GERD ) . Larger RCTs have been relatively short in duration , and have reported mixed results regarding symptom control and effect on quality of life ( QOL ) . Economic evaluations have reported conflicting results . OBJECTIVES To determine the incremental cost-utility of LNF versus PPI for treating patients with chronic and controlled GERD over 3 years from the societal perspective . METHODS Economic evaluation was conducted alongside a RCT that enrolled 104 patients from October 2000 to September 2004 . Primary study outcome was GERD symptoms ( secondary outcomes included QOL and cost-utility ) . Re source utilization and QOL data collected at regular follow-up intervals determined incremental cost/QALY gained . Stochastic uncertainty was assessed using bootstrapping and method ologic assumptions were assessed using sensitivity analysis . RESULTS No statistically significant differences in GERD symptom scores , but LNF did result in fewer heartburn days and improved QOL . Costs were higher for LNF patients by $ 3205/patient over 3 years but QOL was also higher as measured by either QOL instrument . Based on total costs , incremental cost-utility of LNF was $ 29,404/QALY gained using the Health Utility Index 3 . Cost-utility results were sensitive to the utility instrument used ( $ 29,404/QALY for Health Utility Index 3 , $ 31,117/QALY for the Short Form 6D , and $ 76,310/QALY for EuroQol 5D ) and if current lower prices for PPIs were used in the analysis . CONCLUSIONS Results varied depending on re source use/costs included in the analysis , the QOL instrument used , and the cost of PPIs ; however , LNF was generally found to be a cost-effective treatment for patients with symptomatic controlled GERD requiring long-term management The aim of the present study was to evaluate the clinical effect of partial and total fundoplication on extraesophageal symptoms in a selected cohort of patients with gastroesophageal reflux disease ( GERD ) . Hundred patients with documented GERD were r and omized to either undergo floppy Nissen ( n=50 ) or Toupet fundoplication ( n=50 ) . Symptom scores of cough , asthma , hoarseness , and distortion of taste were prospect ively evaluated using a st and ardized symptom question naire before surgery and at 3- and 12-month follow-up . Statistical significance was set at a P-value of 0.05 . All evaluated symptoms exhibited substantial improvement after Nissen fundoplication at 3- and 12-month follow-up . Similar therapeutic results were documented for Toupet fundoplication , although statistical significance could not be reached for asthma at long-term follow-up . In conclusion , the application of laparoscopic fundoplication is justified for patients with documented GERD and atypical symptoms refractory to medical treatment . Toupet fundoplication may have a lesser effect on asthma Anterior partial fundoplication ( AF ) has been popularized by a lower risk of mechanical side effects . The question then emerges whether anterior partial wrap has a similar antireflux effect with Nissen fundoplication ( NF ) . We therefore conducted a r and omized study to compare the long-term outcome of anterior fundoplication with NF . One hundred patients who enrolled in the trial from May 2003 to March 2005 were r and omized to laparoscopic AF or laparoscopic NF . Endoscopy , pH monitoring , manometry , a detailed question naire , and a visual analog symptom score were completed preoperative at 6 , 12 , 24 , and 60 months after surgical procedures . The postoperative adverse effects such as dysphagia and flatulence were compared between the two groups . Revision surgery or maintenance proton pump inhibitor therapy was defined as failure . Fifty procedures were performed in each group . The outcome at 5 years follow-up was determined for 96 patients ( 96 % ; 49 patients in the AF group and 47 in the NF group ) . Three patients ( 3 % ) died of unrelated causes during follow-up , and one patient changed address . Both fundoplications were found to provide good control of reflux-related symptoms in most of the patients . For 96 patients followed up more than 5 years , gastroesophageal reflux symptoms were well controlled in 81 patients ( 84.38 % ) ; the mean DeMeester scores in the AF group decreased from 106.89 ± 14.12 to 12.67 ± 3.14 and in the NF group from 109.51 ± 17.98 to 10.81 ± 2.65 , and the esophagitis was ameliorated visibly . Moreover , there were significantly fewer patients in the AF group who complained of flatulence . Compared with NF , anterior 180 ° partial fundoplication is an effective treatment of gastroesophageal reflux and associates with fewer postoperative adverse effects Background The fundoplication of choice for the surgical treatment of gastroesophageal reflux disease ( GERD ) still is debated . Multichannel intraluminal impedance monitoring ( MII ) has not been used to compare objective data , and comparative subjective data on laparoscopic Nissen and Toupet fundoplications are scarce . Methods This study r and omly allocated 125 patients with Output:

Regurgitation , morbidity , and reoperation were similar across treatments , albeit these were associated with very low- quality evidence . Laparoscopic 270 ° fundoplication achieves a better outcome than 360 ° total fundoplication , especially in terms of postoperative dysphagia , although other types of partial fundoplication might be equally effective .

MS2_1shot442

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Abstract Objective : To evaluate the use of a computerised support system for decision making for implementing evidence based clinical guidelines for the management of asthma and angina in adults in primary care . Design : A before and after pragmatic cluster r and omised controlled trial utilising a two by two incomplete block design . Setting : 60 general practice s in north east Engl and . Participants : General practitioners and practice nurses in the study practice s and their patients aged 18 or over with angina or asthma . Main outcome measures : Adherence to the guidelines , based on review of case notes and patient reported generic and condition specific outcome measures . Results : The computerised decision support system had no significant effect on consultation rates , process of care measures ( including prescribing ) , or any patient reported outcomes for either condition . Levels of use of the software were low . Conclusions : No effect was found of computerised evidence based guidelines on the management of asthma or angina in adults in primary care . This was probably due to low levels of use of the software , despite the system being optimised as far as was technically possible . Even if the technical problems of producing a system that fully supports the management of chronic disease were solved , there remains the challenge of integrating the systems into clinical encounters where busy practitioners manage patients with complex , multiple conditions We developed a computer-stored medical record system containing a limited set of the total clinical data base -- primarily diagnostic studies and treatments . This system responds to its own content according to physician-authored reminder rules . To determine the effect of the reminder messages generated by 1490 rules on physician behavior , we r and omly assigned practitioners in a general medicine clinic to study or control groups . The computer found indications for six different actions per patient in 12 467 patients during a 2-year study : 61 study group residents who received computer reminders responded to 49 % of these indications ; 54 control group residents , to only 29 % ( p less than 0.0001 ) . Preventive care ( occult blood testing , mammographic screening , weight reduction diets , influenza and pneumococcal vaccines ) was affected . The intentions of the study group to use a given action for an indication predicted their response to the indications ( p less than 0.03 , r2 = 0.33 ) . The intentions of the control residents did not OBJECTIVE To assess the impact and cost-effectiveness of two information-based provider reminder interventions design ed to improve self-care management and outcomes of heart failure ( HF ) patients . DATA SOURCES / STUDY SETTING Interview and agency administrative data on 628 home care patients with a primary diagnosis of HF . STUDY DESIGN Patients were treated by nurses r and omly assigned to usual care or one of two intervention groups . The basic intervention was an e-mail to the patient 's nurse highlighting six HF-specific clinical recommendations . The augmented intervention supplemented the initial nurse reminder with additional clinician and patient re sources . DATA COLLECTION Patient interviews were conducted 45 days post admission to measure self-management behaviors , HF-specific outcomes ( Kansas City Cardiomyopathy Question naire-KCCQ ) , health-related quality of life ( EuroQoL ) , and service use . PRINCIPAL FINDINGS Both interventions improved the mean KCCQ summary score ( 15.3 and 12.9 percent , respectively ) relative to usual care ( p < or = .05 ) . The basic intervention also yielded a higher EuroQoL score relative to usual care ( p < or = .05 ) . In addition , the interventions had a positive impact on medication knowledge , diet , and weight monitoring . The basic intervention was more cost-effective than the augmented intervention in improving clinical outcomes . CONCLUSIONS This study demonstrates the positive impact of targeting evidence -based computer reminders to home health nurses to improve patient self-care behaviors , knowledge , and clinical outcomes . It also advances the field 's limited underst and ing of the cost-effectiveness of selected strategies for translating research into practice OBJECTIVE —The purpose of this study was to determine whether implementation of a multicomponent organizational intervention can produce significant change in diabetes care and outcomes in community primary care practice s. RESEARCH DESIGN AND METHODS —This was a group-r and omized , controlled clinical trial evaluating the practical effectiveness of a multicomponent intervention ( TRANSLATE ) in 24 practice s. The intervention included implementation of an electronic diabetes registry , visit reminders , and patient-specific physician alerts . A site coordinator facilitated previsit planning and a monthly review of performance with a local physician champion . The principle outcomes were the percentage of patients achieving target values for the composite of systolic blood pressure ( SBP ) < 130 mmHg , LDL cholesterol < 100 mg/dl , and A1C < 7.0 % at baseline and 12 months . Six process measures were also followed . RESULTS —Over 24 months , 69,965 visits from 8,405 adult patients with type 2 diabetes were recorded from 238 health care providers in 24 practice s from 17 health systems . Diabetes process measures increased significantly more in intervention than in control practice s , giving net increases as follows : foot examinations 35.0 % ( P < 0.0.001 ) ; annual eye examinations 25.9 % ( P < 0.001 ) ; renal testing 28.5 % ( P < 0.001 ) ; A1C testing 8.1%(P < 0.001 ) ; blood pressure monitoring 3.5 % ( P = 0.05 ) ; and LDL testing 8.6 % ( P < 0.001 ) . Mean A1C adjusted for age , sex , and comorbidity decreased significantly in intervention practice s ( P < 0.02 ) . At 12 months , intervention practice s had significantly greater improvement in achieving recommended clinical values for SBP , A1C , and LDL than control clinics ( P = 0.002 ) . CONCLUSIONS — Introduction of a multicomponent organizational intervention in the primary care setting significantly increases the percentage of type 2 diabetic patients achieving recommended clinical outcomes BACKGROUND Our objective was to test the effect of physicians providing brief health lifestyle counseling to patients with type 2 diabetes mellitus during usual care visits . METHODS We conducted a r and omized controlled trial of a 12-month intervention at 2 large community health centers , enrolling 310 patients with a body mass index ( calculated as weight in kilograms divided by height in meters squared ) of 25 or greater . In the intervention group , self-management goals for nutrition and physical activity were set using a tailored computer program . Goals were then review ed at each clinic visit by physicians . The control group received only printed health education material s. The main outcome measures included change in physical activity and body weight . RESULTS In the intervention group , recommended levels of physical activity increased from 26 % at baseline to 53 % at 12 months ( P < .001 ) compared with controls ( 30 % to 37 % ; P= .27 ) , and 32 % of patients in the intervention group lost 6 or more pounds at 12 months compared with 18.9 % of controls ( odds ratio , 2.2 ; P= .006 ) . CONCLUSION A brief intervention to increase the dialogue between patients and health care providers about behavioral goals can lead to increased physical activity and weight loss The purpose of the study was to compare the proportion of obesity-related diagnoses in clinical encounters ( N = 1874 ) documented by nurses using a personal digital assistant-based log with and without obesity decision support features . The experimental group encounters in the r and omized controlled trial had significantly more ( P = .000 ) obesity-related diagnoses ( 11.3 % ) than did the control group encounters ( 1 % ) and a significantly lower false negative rate ( 24.5 % vs 66.5 % , P = .000 ) . The study findings provide evidence that integration of a decision support feature that automatically calculates an obesity-related diagnosis increases diagnoses and decreases missed diagnoses and suggest that such systems have the potential to improve the quality of obesity-related care Purpose : Physicians and patients frequently miss opportunities to improve the quality of care of diabetes , primarily because of the complexity of managing many risk factors over many years with many other providers . Electronic decision support is a potential way to improve prescribing and quality of care . Shared care , meaning patients and physicians sharing access to the patient ’s status compared to recommended targets , is thought to improve outcomes as are supportive reminders . Our objective was to rigorously evaluate whether an electronic medical record (EMR)-linked , individualized electronic diabetes tracker with automated telephone reminders could improve the quality of diabetes management in primary care . Methods : Community-based family physicians across Ontario who were already using EMRs in their practice , were recruited . Patient and physician versions of a Web-based diabetes tracker , the ( COMPETE II Diabetes Tracker ( CIIDT ) system , were developed . The main tracker page showed all 13 monitoring variables – the patient ’s recent values , both process ( when last checked ) and outcome ( the result ) , target values for process and outcome , and short advisory messages , with red/yellow/green highlighting to indicate urgency of review . Links to best evidence guidelines and patient re sources were provided . The physician view appeared as an overlay in a corner of their own electronic medical record ( N = 6 EMR products ) . Intervention patients were linked to a voice biometric-enabled automated telephone reminder system ( ATRS ) for medications , labs and visits . Consenting patients with diabetes were r and omized to the CIIDT-ATRS intervention or usual care ( neither ) . Since the study was relatively short ( 6 months follow-up ) , the primary outcome was a composite score of process quality – the quality of monitoring the variables compared to target . Secondary outcomes included clinical outcomes plus evaluations of the tracker and ATRS , and impact on health information privacy . Results : Forty-eight physicians ( mean age ( SD ) = 45.2 ( 10.0 ) , 38.2 % female ) were recruited and 511 patients ( mean age ( SD ) = 60.3 ( 12.4 ) , 49.6 % female , 78 % completed high school ) were r and omized . Only 46.1 % of patients used the Internet at least monthly so print versions of their recent information were sent to them prior to their physician visits . There were frequent technical problems with the Web-based tracker and a lack of data integration between the various EMRs and the tracker . Despite problems , the primary outcome of composite score of physician visits , and checks of blood pressure ( BP ) , LDL cholesterol , HbA1C , microalbuminuria , BMI , feet and eyes , showed a highly statistically significant improvement in the intervention group compared to control ( p<0.0001 ) . There were also highly statistically significant improvements in actual blood pressure ( -2.68 mm diastolic BP , p=0.007 ) and in HbA1C ( -.2 % , p=0.001 ) . 75.9 % of intervention patients were as satisfied or more satisfied with their care since the use of the tracker system and 62.5 % voted to continue to receive ATRS reminders . 22.4 % of patients felt that , in general , the risk of possible loss of confidentiality outweighed the benefits that computers could bring to their health . Over the course of the study , physicians developed a more favourable attitude towards the benefits vs risks of computerized systems in healthcare . Discussion : Despite considerable technical challenges for both patients and physicians , we have demonstrated that the care of a complex chronic disease can be improved with electronic tracking and decision support for both physician and patient . This is one of the first r and omized trial to demonstrate success in routine , community-based primary care . Funding Source : Grant from the Canada Health Infostructure Partnerships Program , Health Canada . References : 1 . Branger PJ . van't Hooft A. van der Wouden JC . Moorman PW . van Bemmel JH . Shared care for diabetes : supporting communication between primary and secondary care . International Journal of Medical Informatics 1999 ; 53:133 - 42 . 2 . Jerant AF . Hill DB . Does the use of electronic medical records improve surrogate patient outcomes in outpatient setting s ? Journal of Family Practice 2000;49:349 - 57 . * Dr Lee is deceased Abstract Objective To test the effectiveness of educational interventions in improving detection rates and management of dementia in primary care . Design Unblinded , cluster r and omised , before and after controlled study . Setting General practice s in the United Kingdom ( central Scotl and and London ) between 1999 and 2002 . Interventions Three educational interventions : an electronic tutorial carried on a CD Rom ; decision support software built into the electronic medical record ; and practice based workshops . Participants 36 practice s participated in the study . Eight practice s were r and omly assigned to the electronic tutorial ; eight to decision support software ; 10 to practice based workshops ; and 10 to control . Electronic and manual search es yielded 450 valid and usable medical records . Main outcome measures Rates of detection of dementia and the extent to which medical records showed evidence of improved concordance with guidelines regarding diagnosis and management . Results Decision support software ( P = 0.01 ) and practice based workshops ( P = 0.01 ) both significantly improved rates of detection compared with control . There were no significant differences by intervention in the measures of concordance with guidelines . Conclusions Decision support systems and practice based workshops are effective educational approaches in improving detection rates in dementia Advance directives name a surrogate decision maker or provide written instructions with the intent of extending patient autonomy with respect to end-of-life decisions [ 1 - 3 ] . Supported on various grounds by the public [ 1 ] , physicians [ 4 ] , ethicists [ 5 ] , and legislators Output:

Conclusions A small majority ( just over half ) of CCDSSs improved care processes in chronic disease management and some improved patient health .

MS2_1shot443

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: The purpose of the study was to determine the long-term safety and effectiveness of high-dose immunosuppressive therapy ( HDIT ) followed by autologous hematopoietic cell transplantation ( AHCT ) in advanced multiple sclerosis ( MS ) . TBI , CY and antithymocyte globulin were followed by transplantation of autologous , CD34-selected PBSCs . Neurological examinations , brain magnetic resonance imaging and cerebrospinal fluid ( CSF ) for oligoclonal b and s ( OCB ) were serially evaluated . Patients ( n=26 , mean Exp and ed Disability Status Scale (EDSS)=7.0 , 17 secondary progressive , 8 primary progressive , 1 relapsing/remitting ) were followed for a median of 48 months after HDIT followed by AHCT . The 72-month probability of worsening ⩾1.0 EDSS point was 0.52 ( 95 % confidence interval , 0.30–0.75 ) . Five patients had an EDSS at baseline of ⩽6.0 ; four of them had not failed treatment at last study visit . OCB in CSF persisted with minor changes in the b and ing pattern . Four new or enhancing lesions were seen on MRI , all within 13 months of treatment . In this population with high baseline EDSS , a significant proportion of patients with advanced MS remained stable for as long as 7 years after transplant . Non-inflammatory events may have contributed to neurological worsening after treatment . HDIT/AHCT may be more effective in patients with less advanced relapsing/remitting MS High-dose immunoablative chemotherapy with autologous haematopoietic cell support might be beneficial in the treatment of intractable forms of MS . We mobilised PBPC in 11 patients with secondary progressive MS and finally eight patients were grafted after high-dose BEAM chemotherapy with either in vitro or in vivo T cell depletion . Median EDSS and SNRS scores at the time of inclusion were 6.5 ( 6.5–7.5 ) and 56 ( 44–65 ) , respectively . PBPC mobilisation was safe with no serious adverse effects , and without significant aggravation of disability . One patient improved significantly ( by 1.0 point on EDSS ) after the mobilisation . Two mobilisation failures were observed . No life-threatening events occurred during the transplantation . All grafted patients , except one , at least stabilised their disability status . One patient improved significantly ( by 1.5 points on EDSS ) , two patients improved slightly ( by 0.5 points on EDSS ) , one patient worsened by 1.0 point on the EDSS in 10 months . Improvement occurred with a delay of 2–4 months . Median EDSS and SNRS of grafted patients at the last follow up were 6.5 ( 5.5–8.5 ) and 64 ( 39–73 ) , respectively with median follow-up of 8.5 months . Further follow-up is needed to determine the disease course after complete immune reconstitution . Bone Marrow Transplantation ( 2000 ) 25 , 525–531 Clinical trials have indicated that autologous hematopoietic stem cell transplantation ( HSCT ) can persistently suppress inflammatory disease activity in a subset of patients with severe multiple sclerosis ( MS ) , but the mechanism has remained unclear . To underst and whether the beneficial effects on the course of disease are mediated by lympho-depletive effects alone or are sustained by a regeneration of the immune repertoire , we examined the long-term immune reconstitution in patients with MS who received HSCT . After numeric recovery of leukocytes , at 2-yr follow-up there was on average a doubling of the frequency of naive CD4 + T cells at the expense of memory T cells . Phenotypic and T cell receptor excision circle ( TREC ) analysis confirmed a recent thymic origin of the exp and ed naive T cell subset . Analysis of the T cell receptor repertoire showed the reconstitution of an overall broader clonal diversity and an extensive renewal of clonal specificities compared with pretherapy . These data are the first to demonstrate that long-term suppression of inflammatory activity in MS patients who received HSCT does not depend on persisting lymphopenia and is associated with profound qualitative immunological changes that demonstrate a de novo regeneration of the T cell compartment IMPORTANCE Most patients with relapsing-remitting ( RR ) multiple sclerosis ( MS ) who receive approved disease-modifying therapies experience breakthrough disease and accumulate neurologic disability . High-dose immunosuppressive therapy ( HDIT ) with autologous hematopoietic cell transplant ( HCT ) may , in contrast , induce sustained remissions in early MS . OBJECTIVE To evaluate the safety , efficacy , and durability of MS disease stabilization through 3 years after HDIT/HCT . DESIGN , SETTING , AND PARTICIPANTS Hematopoietic Cell Transplantation for Relapsing-Remitting Multiple Sclerosis ( HALT-MS ) is an ongoing , multicenter , single-arm , phase 2 clinical trial of HDIT/HCT for patients with RRMS who experienced relapses with loss of neurologic function while receiving disease-modifying therapies during the 18 months before enrolling . Participants are evaluated through 5 years after HCT . This report is a prespecified , 3-year interim analysis of the trial . Thirty-six patients with RRMS from referral centers were screened ; 25 were enrolled . INTERVENTIONS Autologous peripheral blood stem cell grafts were CD34 + selected ; the participants then received high-dose treatment with carmustine , etoposide , cytarabine , and melphalan as well as rabbit antithymocyte globulin before autologous HCT . MAIN OUTCOMES AND MEASURES The primary end point of HALT-MS is event-free survival defined as survival without death or disease activity from any one of the following outcomes : ( 1 ) confirmed loss of neurologic function , ( 2 ) clinical relapse , or ( 3 ) new lesions observed on magnetic resonance imaging . Toxic effects are reported using National Cancer Institute Common Terminology Criteria for Adverse Events . RESULTS Grafts were collected from 25 patients , and 24 of these individuals received HDIT/HCT . The median follow-up period was 186 weeks ( interquartile range , 176 - 250 ) weeks ) . Overall event-free survival was 78.4 % ( 90 % CI , 60.1%-89.0 % ) at 3 years . Progression-free survival and clinical relapse-free survival were 90.9 % ( 90 % CI , 73.7%-97.1 % ) and 86.3 % ( 90 % CI , 68.1%-94.5 % ) , respectively , at 3 years . Adverse events were consistent with expected toxic effects associated with HDIT/HCT , and no acute treatment-related neurologic adverse events were observed . Improvements were noted in neurologic disability , quality -of-life , and functional scores . CONCLUSIONS AND RELEVANCE At 3 years , HDIT/HCT without maintenance therapy was effective for inducing sustained remission of active RRMS and was associated with improvements in neurologic function . Treatment was associated with few serious early complications or unexpected adverse events BACKGROUND Autologous non-myeloablative haemopoietic stem cell transplantation is a method to deliver intense immune suppression . We evaluated the safety and clinical outcome of autologous non-myeloablative haemopoietic stem cell transplantation in patients with relapsing-remitting multiple sclerosis ( MS ) who had not responded to treatment with interferon beta . METHODS Eligible patients had relapsing-remitting MS , attended Northwestern Memorial Hospital , and despite treatment with interferon beta had had two corticosteroid-treated relapses within the previous 12 months , or one relapse and gadolinium-enhancing lesions seen on MRI and separate from the relapse . Peripheral blood haemopoietic stem cells were mobilised with 2 g per m2 cyclophosphamide and 10 microg per kg per day filgrastim . The conditioning regimen for the haemopoietic stem cells was 200 mg per kg cyclophosphamide and either 20 mg alemtuzumab or 6 mg per kg rabbit antithymocyte globulin . Primary outcomes were progression-free survival and reversal of neurological disability at 3 years post-transplantation . We also sought to investigate the safety and tolerability of autologous non-myeloablative haemopoietic stem cell transplantation . FINDINGS Between January , 2003 , and February , 2005 , 21 patients were treated . Engraftment of white blood cells and platelets was on median day 9 ( range day 8 - 11 ) and patients were discharged from hospital on mean day 11 ( range day 8 - 13 ) . One patient had diarrhoea due to Clostridium difficile and two patients had dermatomal zoster . Two of the 17 patients receiving alemtuzumab developed late immune thrombocytopenic purpura that remitted with st and ard therapy . 17 of 21 patients ( 81 % ) improved by at least 1 point on the Kurtzke exp and ed disability status scale ( EDSS ) , and five patients ( 24 % ) relapsed but achieved remission after further immunosuppression . After a mean of 37 months ( range 24 - 48 months ) , all patients were free from progression ( no deterioration in EDSS score ) , and 16 were free of relapses . Significant improvements were noted in neurological disability , as determined by EDSS score ( p<0.0001 ) , neurological rating scale score ( p=0.0001 ) , paced auditory serial addition test ( p=0.014 ) , 25-foot walk ( p<0.0001 ) , and quality of life , as measured with the short form-36 ( SF-36 ) question naire ( p<0.0001 ) . INTERPRETATION Non-myeloablative autologous haemopoietic stem cell transplantation in patients with relapsing-remitting MS reverses neurological deficits , but these results need to be confirmed in a r and omised trial High-dose immunosuppressive therapy ( HDIT ) with autologous hematopoietic stem cell transplantation ( AHSCT ) is a promising approach to treatment of multiple sclerosis ( MS ) patients . In this paper , we present the long-term outcomes of a prospect i ve single-center study with the analysis of the safety and efficacy of HDIT + AHSCT with reduced-intensity BEAM-like conditioning regimen in 99 MS patients : mean age—35 years old ; male/female—39/60 ; median Exp and ed Disability Status Scale ( EDSS ) = 3.5 ; 43 relapsing/remitting MS , 56 progressive MS . No transplant-related deaths were observed . The mobilization and transplantation procedures were well tolerated . At 6 months post-transplant , neurological improvement or stabilization was observed in all the patients except one . Cumulative incidence of disease progression was 16.7 % at 8 years after HDIT + AHSCT . Estimated event-free survival at median follow-up of 48.9 months was 80 % : 83.3 % in relapsing/remitting MS vs 75.5 % in progressive MS . Sixty-four patients who did not progress during the first 3 years post-transplant and were monitored for more than 3 years were included in long-term outcome analysis . At the median long-term follow-up of 62 months , 47 % of patients improved by at least 0.5 points on the EDSS scale as compared to baseline and exhibited improvement during the entire period of follow-up ; 45 % of patients were stable . No active , new , or enlarging lesions on magnetic resonance imaging were registered in patients without disease progression . AHSCT was accompanied by a significant improvement in patient ’s quality of life . Due to the fact that patient selection was quite different to the other studies and that the information about disease activity prior in the disease course and its treatment was inhomogeneous , comparison with the results in the literature should be done with caution . Thus , the risk/benefit ratio of HDIT + AHSCT with reduced-intensity BEAM-like conditioning regimen in our population of MS patients is very favorable . The consistency of our long-term clinical and quality of life results , together with the persistence of improvement , is in favor of the efficacy and safety of this treatment approach in MS patients OBJECTIVE To explore the safety and effectiveness of high-dose cyclophosphamide ( HiCy ) without bone marrow transplantation in patients with aggressive multiple sclerosis ( MS ) . DESIGN A 2-year open-label trial of patients with aggressive relapsing-remitting multiple sclerosis ( RRMS ) given an immunoablative regimen of HiCy ( 50 mg/kg/d for 4 consecutive days ) with no subsequent immunomodulatory therapy unless disease activity reappeared that required rescue therapy . SETTING The Johns Hopkins University Multiple Sclerosis Center , Baltimore , Maryl and . Patients A total of 21 patients with RRMS were screened for eligibility and 9 patients were enrolled in the trial . Patients were required to have 2 or more gadolinium-enhancing lesions on each of 2 pretreatment magnetic resonance imaging scans , at least 1 clinical exacerbation in the 12 months prior to HiCy treatment , or a sustained increase of 1.0 point or higher on the Exp and ed Disability Status Scale ( EDSS ) in the preceding year . Intervention Patients received 50 mg/kg/d of cyclophosphamide intravenously for 4 consecutive days Output:

However , meta-regression analysis did not find the source of heterogeneity in which the publication country and follow up time were the influencing factors . Available evidence suggests some clinical benefits of HCT combined with immunotherapy on MS .

MS2_1shot444

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Neuroimaging is known to complement clinical findings in the diagnostic work up of parkinsonian syndromes . Recently , transcranial ultrasound was reported to have a high diagnostic yield in differentiating idiopathic Parkinson ’s disease ( IPD ) from atypical parkinsonian syndromes . This report summarises the sonographic findings of 102 patients with IPD , 34 patients with multiple system atrophy , and 21 patients with progressive supranuclear palsy . Increased echogenicity of the substantia nigra is predictive for IPD whereas a low echogenic substantia nigra , particularly when combined with a hyperechogenic lentiform nucleus , strongly suggests an atypical Parkinsonian syndrome . The underlying causes for the differential echo pattern of the substantia nigra remain unknown Background Hyperechogenicity of the substantia nigra ( SN+ ) , detected by transcranial sonography ( TCS ) , was reported as a characteristic finding in Parkinson 's disease ( PD ) , with high diagnostic accuracy values , when compared mainly to healthy controls or essential tremor ( ET ) group . However , some data is accumulating that the SN + could be detected in other neurodegenerative and even in non-neurodegenerative disorders too . Our aim was to estimate the diagnostic accuracy of TCS , mainly focusing on the specificity point , when applied to a range of the parkinsonian disorders , and comparing to the degenerative cognitive syndromes . Methods A prospect i ve study was carried out at the Hospital of Lithuanian University of Health Sciences from January until September 2011 . Initially , a TCS and clinical examination were performed on 258 patients and 76 controls . The General Electric Voluson 730 Expert ultrasound system was used . There were 12.8 % of cases excluded with insufficient temporal bones , and 4.3 % excluded with an unclear diagnosis . The studied sample consisted of the groups : PD ( n = 71 , 33.2 % ) , ET ( n = 58 , 27.1 % ) , PD and ET ( n = 10 , 4.7 % ) , atypical parkinsonian syndromes ( APS ) ( n = 3 , 1.4 % ) , hereditary neurodegenerative parkinsonism ( HDP ) ( n = 3 , 1.4 % ) , secondary parkinsonism ( SP ) ( n = 23 , 10.8 % ) , mild cognitive impairment ( MCI ) ( n = 33 , 15.4 % ) , dementia ( n = 13 , 6.1 % ) , and control ( n = 71 ) . Results There were 80.3 % of PD patients at stages 1 & 2 according to Hoehn and Yahr . At the cut-off value of 0.20 cm2 of the SN+ , the sensitivity for PD was 94.3 % and the specificity - 63.3 % ( ROC analysis , AUC 0.891 ) , in comparison to the rest of the cohort . At the cut-off value of 0.26 cm2 , the sensitivity was 90 % and the specificity 82.4%.The estimations for the lowest specificity for PD , in comparison to the latter subgroups ( at the cut-off values of 0.20 cm2 and 0.26 cm2 , respectively ) were : 0 % and 33.3 % to APS , 33.3 % and 66.7 % to HDP , 34.8 % and 69.6 % to SP , 55.2 % and 82.8 % to ET , 75 % and 91.7 % to dementia . Conclusions The high sensitivity of the test could be employed as a valuable screening tool . But TCS is more useful as a supplementary diagnostic method , due to the specificity values not being comprehensive Background Essential tremor ( ET ) and Parkinson ’s disease ( PD ) are considered distinct disorders . The aim of the study was to look for a link or any distinguishing features by transcranial sonography ( TCS ) , together with the clinical examination findings in a group of patients with overlapping phenotype of ET and PD ( ET-PD ) . Methods A prospect i ve observational case-control study was carried out from the 3rd January 2011 until 30th January 2013 at the Hospital of Lithuanian University of Health Sciences . The final study group consisted of 15 patients with ET-PD , 116 patients with ET-only and 141 patients with PD-only . The control group included 101 subjects . Clinical diagnosis was of a diagnostic st and ard . Results The main ultrasonographic findings in the ET-PD group were similar to those of the PD-only : hyperechogenicity of the substantia nigra ( 66.7 % , p < 0.001 ) and nuclei raphe interruptions/absence ( 38.5 % , p < 0.001 ) . The single distinguishing TCS finding in ET-PD group was a lentiform nucleus hyperechogenicity ( 26.7 % ) , however this was only significant when compared to controls ( p = 0.006 ) . An asymmetrical onset of symptoms ( 73.3 % ) in ET-PD group was characteristic to PD-only . The ET-PD patients had the longest disease duration ( median 6 years , p < 0.001 ) , the most frequent rate of positive family history ( 53.3 % , p = 0.005 ) , rather low prevalence of cogwheel rigidity ( 26.7 % , p < 0.001 ) , and higher mean Hoehn & Yahr scores compared to PD-only ( 2.6 ± 0.8 vs. 1.8 ± 0.8 , p = 0.012 ) . Conclusions The main TCS findings of the present study in patients with overlapping ET-PD phenotype were similar to the PD-only group . The highest positive family history rate among ET-PD patients indicates a strong hereditary predisposition and needs genetic underpinnings . Some ET patients , who look like they may be developing co-morbid PD clinical ly , may have an alternative diagnosis for Parkinsonism , which could be delineated by TCS examination Background This study examines the clinical accuracy of movement disorder specialists in distinguishing tremor dominant Parkinson 's disease ( TDPD ) from other tremulous movement disorders by the use of st and ardised patient videos . Patients and methods Two movement disorder specialists were asked to distinguish TDPD from patients with atypical tremor and dystonic tremor , who had no evidence of presynaptic dopaminergic deficit ( subjects without evidence of dopaminergic deficit ( SWEDDs ) ) according to 123I-N-ω-fluoro-propyl- 2β-carbomethoxy-3β-(4-iodophenyl ) nortropane ( [ 123I ] FP-CIT ) single photon emission computed tomography ( SPECT ) , by ‘ blinded ’ video analysis in 38 patients . A diagnosis of parkinsonism was made if the step 1 criteria of the Queen Square Brain Bank criteria for Parkinson 's disease were fulfilled . The review er diagnosis was compared with the working clinical diagnosis drawn from the medical history , SPECT scan result , long term follow-up and in some cases the known response to dopaminergic medications . This comparison allowed a calculation for false positive and false negative rate of diagnosis of PD . Results High false positive ( 17.4 - 26.1 % ) and negative ( 6.7 - 20 % ) rates were found for the diagnosis of PD . The diagnostic distinction of TDPD from dystonic tremor was reduced by the presence of dystonic features in treated and untreated PD patients . Conclusion Clinical distinction of TDPD from atypical tremor , monosymptomatic rest tremor and dystonic tremor can be difficult due to the presence of parkinsonian features in tremulous SWEDD patients . The diagnosis of bradykinesia was particularly challenging . This study highlights the difficulty of differentiation of some cases of SWEDD from PD BACKGROUND In several pilot studies , transcranial brain sonography findings of substantia nigra and lenticular nucleus discriminated between idiopathic Parkinson disease ( PD ) and atypical parkinsonian disorders . OBJECTIVE To study the use of transcranial brain sonography in excluding the diagnosis of idiopathic PD in patients with sporadic parkinsonism . DESIGN AND SETTING All patients with parkinsonism admitted to our movement disorder clinic from January 1 , 2003 , through December 31 , 2005 , who fulfilled clinical diagnostic criteria for definite PD , probable parkinsonian variant of multiple-system atrophy ( MSA-P ) , or probable progressive supranuclear palsy ( PSP ) were prospect ively studied with transcranial brain sonography by an investigator blinded to clinical diagnoses . Patients Eligible patients included 138 with sporadic idiopathic PD ( 82 men and 56 women ; mean + /- SD age , 67.1 + /- 9.8 years ; mean + /- SD disease duration , 7.5 + /- 6.3 years ; mean + /- SD motor score on the Unified Parkinson Disease Rating Scale , 32.6 + /- 18.1 ) , 21 with MSA-P ( 10 men and 11 women ; mean + /- SD age , 65.4 + /- 9.5 years ; mean + /- SD duration of disease , 3.1 + /- 2.0 years ; mean + /- SD motor score , 33.5 + /- 16.1 ) , and 22 with PSP ( 13 men and 9 women ; mean + /- SD age , 71.2 + /- 5.5 years ; mean + /- SD duration of disease , 3.4 + /- 2.4 years ; mean + /- SD motor score , 46.2 + /- 18.9 ) . In 7 patients , transcranial brain sonography was not possible owing to insufficient temporal acoustic bone windows . MAIN OUTCOME MEASURES Sensitivity , specificity , and predictive value of transcranial brain sonography in indicating an atypical parkinsonian syndrome rather than idiopathic PD in patients with sporadic parkinsonism . RESULTS Normal echogenic substantia nigra indicated MSA-P rather than PD ( sensitivity , 90 % ; specificity , 98 % ; positive predictive value , 86 % ) , whereas third-ventricle dilatation of more than 10 mm in combination with lenticular nucleus hyperechogenicity indicated PSP rather than PD ( sensitivity , 84 % ; specificity , 98 % ; positive predictive value , 89 % ) . Normal echogenic substantia nigra combined with lenticular nucleus hyperechogenicity indicated MSA-P or PSP ( sensitivity , 59 % ; specificity , 100 % ; positive predictive value , 100 % ) . In parkinsonism with age at onset younger than 60 years , normal echogenic substantia nigra alone indicated MSA-P or PSP ( sensitivity , 75 % ; specificity , 100 % ; positive predictive value , 100 % ) . CONCLUSIONS Distinct transcranial brain sonography findings can exclude the diagnosis of PD in patients with sporadic parkinsonism . Sonographic discrimination of atypical parkinsonian syndromes from PD is clearer in patients with onset of parkinsonism at younger than 60 years BACKGROUND AND OBJECTIVE Publication bias and other sample size effects are issues for meta-analyses of test accuracy , as for r and omized trials . We investigate limitations of st and ard funnel plots and tests when applied to meta-analyses of test accuracy and look for improved methods . METHODS Type I and type II error rates for existing and alternative tests of sample size effects were estimated and compared in simulated meta-analyses of test accuracy . RESULTS Type I error rates for the Begg , Egger , and Macaskill tests are inflated for typical diagnostic odds ratios ( DOR ) , when disease prevalence differs from 50 % and when thresholds favor sensitivity over specificity or vice versa . Regression and correlation tests based on functions of effective sample size are valid , if occasionally conservative , tests for sample size effects . Empirical evidence suggests that they have adequate power to be useful tests . When DORs are heterogeneous , however , all tests of funnel plot asymmetry have low power . CONCLUSION Existing tests that use st and ard errors of odds ratios are likely to be seriously misleading if applied to meta-analyses of test accuracy . The effective sample size funnel plot and associated regression test of asymmetry should be used to detect publication bias and other sample size related effects Transcanial sonography ( TCS ) is increasingly applied in the diagnosis of Parkinson 's disease ( PD ) , but investigator bias may influence the results of examination . Blinding the sonographer to the clinical diagnosis of 42 PD patients and 35 controls , we obtained a positive predictive value of 85.7 % and a negative predictive value of 82.9 % in the diagnosis of PD solely by interpreting the results of TCS , indicating that TCS is a valuable additional tool in the diagnosis of PD Article abstract -To detect morphologic abnormalities in Parkinson 's disease ( PD ) , we examined 30 patients with PD and 30 age- and sex-matched nonparkisonian controls by transcranial color-coded real-time sonography ( TCCS ) . In 12 severely affected PD patients , the echogenicity of the substantia nigra was distinctly increased . In the remaining 18 PD patients and in all controls , the substantia nigra was poorly visualized or nondetectable by TCCS . The Output:

Our systematic review of the literature and meta- analysis suggest that TCS has high diagnostic accuracy in the diagnosis of PD when compared to healthy control

MS2_1shot445

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: AIM To assess whether the effectiveness of a combination of transarterial chemoembolization ( TACE ) and percutaneous ethanol injection ( PEI ) in the treatment of unresectable hepatocellular carcinoma ( HCC ) is superior to TACE alone a r and omized controlled trial was performed . METHODS The effect of combination therapy on long-term survival rates and duration of hospitalization was evaluated in 52 previously untreated HCCs , r and omly allocated to TACE-PEI ( 27 pts ) or TACE alone ( 25 pts ) . RESULTS The cumulative survival rate of the TACE group was 75.8 % at 6 mo , 62.9 % at 12 mo , and 18.0 % at 24 mo and of the TACE-PEI group 76.9 % , 61.5 % , and 38.7 % , respectively . Comparison of overall survival in both groups showed no statistically significant difference . Regarding the patients with HCCs Okuda stage I ( n = 26 ) , the median survival of the TACE-PEI group was significantly longer ( > 24 mo , median not yet reached in the study period ) compared to the TACE group ( 18.4 mo [ range 11.6 - 21.7 mo ] ; P = 0.04 ) . TACE-PEI reduced the relative risk for mortality to 0.4 ( 95%CI 0.15 - 0.96 ) compared to patients who received TACE alone . Median survival in patients with HCCs Okuda stage II or III was 5.0 mo in the TACE group ( 1.7 mo-not defined ) compared to 10.4 mo in the TACE-PEI group . CONCLUSION The combination TACE-PEI improved survival time compared to TACE alone . Our study revealed a statistically significant improved survival in HCCs Okuda stage I. Side effects were minor and the combination therapy did not prolong duration of hospitalization considerably Context Per capita Medicare spending varies considerably from region to region . The effect of greater Medicare spending on mortality , functional status , and satisfaction is not known . Contribution Using end-of-life care spending as an indicator of Medicare spending , the research ers categorized geographic regions into five quintiles of spending and examined costs and outcomes of care for hip fracture , colorectal cancer , and acute myocardial infa rct ion . Residents of high-spending regions received 60 % more care but did not have lower mortality rates , better functional status , or higher satisfaction . Implication s Medicare beneficiaries who live in higher Medicare spending regions do not necessarily have better health outcomes or satisfaction with health care than those in lower-spending regions . The Editors The inexorable growth of health care spending in the United States is widely believed to be due to the greater use of advanced technology of clear-cut benefit ( 1 ) . Policymakers argue ( and the public assumes ) that any constraints on growth are likely to be harmful ( 1 , 2 ) . Studies of regional variations in spending and medical practice , however , call these assumptions into question . Earlier research has indicated that the nearly twofold differences in Medicare spending observed across U.S. regions are not due to differences in the prices paid for medical services ( 3 , 4 ) or to differences in health or socioeconomic status ( 3 , 5 , 6 ) . Recent research , some of which is presented in Part 1 of our study , indicates that regional variations in average per capita Medicare spending are not due to more frequent performance of major surgery ( 7 , 8) and that regions with higher per capita spending are no more likely to provide higher- quality care , whether defined in terms of specific evidence -based services or in terms of greater access to basic health care ( 7 , 8) . The additional utilization in high-spending regions is largely devoted to discretionary services that have previously been demonstrated to be associated with the local supply of physicians and hospital re sources ( 5 , 6 ) . These include the frequency and type of evaluation and management services provided by physicians , the use of specialist consultations , the frequency of diagnostic tests and minor procedures , and the likelihood of treating patients with chronic disease in the inpatient or intensive care unit setting . Whether the specialist-oriented , more inpatient-based practice observed in high-spending regions offers important health benefits , however , is unknown . Although recent studies have found no benefit in terms of mortality ( 5 , 9 , 10 ) , they had limited ability to adjust for possible case-mix differences , inadequate individual-level clinical detail , and limited outcome measures . Our study was design ed to address these concerns . In Part 1 , we reported on the relationship between regional differences in spending and the content of care , quality of care , and access to care provided to four cohorts of Medicare beneficiaries . In this article , Part 2 , we describe associations between increased spending and mortality , functional status , and satisfaction with care . Methods Design Overview As described in greater detail in Part 1 , we carried out a cohort study in four parallel population s using a natural r and omization approach ( 11 ) . In this approach , one or more exposure variables allow assignment of patients into treatment groups ( different levels of average spending ) , as would a r and omized trial . Because some of the regional differences in Medicare spending are due to differences in illness levels ( enrollees in Louisiana are sicker than those in Colorado ) and price ( Medicare pays more for the same service in New York than in Iowa ) , we could not use Medicare spending itself as the exposure . We therefore assigned U.S. hospital referral regions ( HRRs ) , and thus the cohort members residing within them , to different exposure levels using a measure that reflects the component of regional variation in Medicare spending due to physician practice rather than regional differences in illness or pricethe End-of-Life Expenditure Index ( EOL-EI ) . Because regional differences in end-of-life spending are unrelated to underlying illness levels , it is reasonable to consider residence in HRRs with differing levels of end-of-life spending as a r and om event . The index was calculated as spending on hospital and physician services provided to a reference cohort distinct from the study cohorts : Medicare enrollees in their last 6 months of life . In the current paper , we also present several analyses with an alternative exposure measure , the Acute Care Expenditure Index ( AC-EI ) , to decrease concern about possible residual confounding . We confirmed that the exposures used to assign the HRRs achieved the goals of natural r and omization : 1 ) Study sample s assigned to different levels of the exposure [ the EOL-EI ] were similar in baseline health status , and 2 ) the actual quantity of services delivered to the individuals within the study sample s nevertheless differed substantially across exposure levels and was highly correlated with average per capita Medicare spending in the HRRs . We followed the cohorts for up to 5 years after their initial hospitalizations and compared the processes of care ( Part 1 ) and health outcomes ( Part 2 ) across HRRs assigned to different exposure levels . Study Cohorts The four study cohorts are described in detail in Part 1 . Briefly , we studied fee-for-service Medicare enrollees , ages 65 to 99 years , who were eligible for Medicare Parts A and B. The acute myocardial infa rct ion ( MI ) cohort was drawn from patients included in the Cooperative Cardiovascular Project , who had index hospitalizations between February 1994 and November 1995 . The hip fracture and colorectal cancer cohorts were identified based on an incident hospitalization between 1993 and 1995 . The general population sample included participants in the Medicare Current Beneficiary Survey ( MCBS ) who had initial interviews between 1991 and 1996 ( for the survival analysis ) or between 1992 and 1995 ( for the other analyses ) ( see Appendix , Section C ) . Each cohort member was placed in a spending group according to the EOL-EI ( as defined in detail in Part 1 ) in their HRR of residence at the time of the index hospitalization ( chronic disease cohorts ) , or initial interview ( MCBS cohort ) . Characteristics of the study cohorts were ascertained from a variety of sources , as described in detail in Part 1 , including Medicare administrative files and cl aims ( all four cohorts ) , chart review s ( acute MI cohort ) , in-person interview ( MCBS cohort ) , U.S Census data ( attributes of ZIP code of residence , such as income , for the three chronic disease cohorts ) , and American Hospital Association data ( to characterize hospitals ) . Assignment to Exposure Levels As we summarized here and described in detail in Part 1 , we used two approaches to determine cohort members ' exposure to different levels of Medicare spending in their HRR of residence . Previous research has shown that the dramatic differences in end-of-life treatment across U.S. regions are highly predictive of differences in total spending ( 8 , 12 ) but are not due to differences in case mix or patient preferences ( 13 ) . Our primary measure of exposure was the EOL-EI , which was calculated as age-sex-raceadjusted spending ( measured with st and ardized national prices ) on hospital and physician services provided to Medicare enrollees who were in their last 6 months of life in each of the 306 U.S. HRRs in mid-1994 to 1997 , excluding any members of the study cohorts ( Appendix , Section E ) We also repeated the major analyses with an alternative exposure measure , the AC-EI , which was based on differences across HRRs in risk-adjusted spending during an acute illness episode ( Appendix , Section F ) . Both measures were highly predictive of average age-sex-raceadjusted Medicare spending at the HRR level ( r = 0.81 for the EOL-EI and 0.79 for the AC-EI in the acute MI cohort ) and , as was shown in Part 1 , of the regional differences in utilization experienced by the study cohorts . For many analyses , we grouped HRRs into quintiles of increasing exposure to the expenditure indices . Statistical Analyses To assess the aggregate impact of any differences in individual attributes on average baseline risk for death across regions of increasing EOL-EI , we used logistic regression to determine each individual 's predicted 1-year risk for death as a function of his or her baseline characteristics . The models had modest to excellent predictive ability ( c-statistics were 0.61 for the colorectal cancer cohort , 0.68 for the hip fracture cohort , 0.77 for the acute MI cohort , and 0.82 for the MCBS cohort ) . We used these models to determine the average predicted risk for death across quintiles of Medicare expenditure indices . Mortality Analyses The association between the HRR-level expenditure index and survival was assessed by using Cox proportional-hazards regression models ( 14 ) , with the expenditure index measured both as a categorical variable ( in which each HRR was assigned to a quintile of Medicare spending based on the EOL-EI ) and a continuous variable ( using the value of the EOL-EI in the HRR of residence as the exposure ) . The survival models included independent variables to adjust for patient characteristics , hospital characteristics , and attributes of the HRR . Model fit was assessed by using methods for Cox model residuals to examine overall model fit , to test proportional hazards assumptions , and to identify influential observations . The main survival models underpredicted mortality in the first 6 months , possibly because of short-term complications that could not be adequately predicted with the available data ; however , the models provided excellent prediction of 1-year mortality rates for each cohort . The models are presented in Appendix Tables 6 , 7 , 8 , and 9 . To test whether the overall findings were BACKGROUND Cisplatin-based chemotherapy improves survival in advanced non-small-cell lung cancer . Using data from phase III trials of mitomycin , ifosfamide and cisplatin , this paper investigates whether the beneficial effect of chemotherapy on survival and quality of life seen overall is limited to certain patient subgroups . PATIENTS AND METHODS The survival benefit of chemotherapy was compared with st and ard treatment using hazard ratios for subgroups specified by stage , sex , age , histology and performance status ( PS ) . The effect on quality of life was investigated for three subgroups defined by performance status . RESULTS The overall unstratified hazard ratio for all 797 eligible patients shows a 16 % reduction in the risk of death with chemotherapy ( P = 0.02 ) . This benefit was seen for both locally advanced and extensive stage disease ( significantly in extensive disease ) . Subgroups defined by sex , age and histology consistently benefitted from chemotherapy . The hazard ratios for the three levels of performance status suggest that PS2 patients gain no survival benefit from chemotherapy . In contrast , these patients experienced the greatest improvement in quality of life during the first six weeks of chemotherapy . CONCLUSIONS Subgroup analysis suggests that the prolongation of life from cisplatin-based chemotherapy is confined to PS0/1 patients . Palliation is greater in PS2 patients Abstract Objective : To describe doctors ' prognostic accuracy in terminally ill patients and to evaluate the determinants of that accuracy . Design : Prospect i ve cohort study Setting : Five outpatient hospice programmes in Chicago Participants : 343 doctors provided survival estimates for 468 terminally ill patients at the time of hospice referral Main outcome measures : Patients ' estimated and actual survival . Results : Median survival was 24 days . Only 20 % ( 92/468 ) of predictions were accurate ( within 33 % of actual survival ) ; 63 % ( 295/468 ) were overoptimistic and 17 % ( 81/468 ) were overpessimistic . Overall , doctors overestimated survival by a factor of 5.3 . Few patient or doctor characteristics were associated with prognostic accuracy . Male patients were 58 % less likely to have overpessimistic predictions . Non-oncology medical specialists were 326 % more likely than general internists to make overpessimistic predictions . Doctors in the upper quartile of practice experience Output:

Despite different cancer characteristics , a fairly universal picture of terminal disease included decreasing performance status , advancing age , weight loss , metastatic disease , disease recurrence , and laboratory abnormalities indicating extensive disease . Most of the prognostic indicators found were continuous , independent risk factors for mortality . We found little evidence that treatment improved survival at these terminal stages , with increased risk for toxicity . CONCLUSION This systematic review summarizes prognostic factors in advanced cancer that are consistently associated with a median survival of 6 months or less . There is little evidence that treatment prolongs survival at this stage

MS2_1shot446

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: It has been proposed that somatosensory stimulation in the form of electromyographically triggered neuromuscular electrical stimulation ( NMES ) to the peripheral nerve can influence functional measures of motor performance in subjects with stroke and can additionally produce changes in cortical excitability . Using a controlled , double-blind design , we studied the effects of intensive ( 60 h/3 weeks ) treatment at home with NMES compared with a sham treatment , applied to the extensor muscles of the hemiplegic forearm to facilitate h and opening in 16 chronic stroke subjects . We investigated improvement in functional use of the h and and change in cortical activation as measured by functional magnetic resonance imaging ( fMRI ) . Following treatment , subjects improved on measures of grasp and release of objects ( Box and Block Test and Jebsen Taylor H and Function Test [ JTHFT ] : small objects , stacking , heavy cans ) , isometric finger extension strength , and self-rated Motor Activity Log ( MAL ) : Amount of Use and How Well score . The sham subjects did not improve on any grasp and release measure or self-rated scale , but did improve on isometric finger extension strength . Importantly , however , following crossover , these subjects improved further in the measure of strength , grasp and release ( Box and Block [ JTHFT ] : page turning ) , and self-rated MAL : Amount of Use score and How Well score . Using fMRI and a finger-tracking task , an index of cortical intensity in the ipsilateral somatosensory cortex increased significantly from pre-test to post-test following treatment . Cortical activation , as measured by voxel count , did not change . These findings suggest that NMES may have an important role in stimulating cortical sensory areas allowing for improved motor function BACKGROUND AND PURPOSE It has been suggested that cyclic neuromuscular electrical stimulation ( ES ) may enhance motor recovery after stroke . We have investigated the effects of ES of the wrist extensors on impairment of wrist function and on upper-limb disability in patients being rehabilitated after acute stroke . METHODS We recruited 60 hemiparetic patients ( mean age , 68 years ) 2 to 4 weeks after stroke into a r and omized , controlled , parallel-group study comparing st and ard rehabilitation treatment with st and ard treatment plus ES of wrist extensors ( 3 times 30 minutes daily for 8 weeks ) . Isometric strength of wrist extensors was measured using a device built for that purpose . Upper-limb disability was assessed with use of the Action Research Arm Test ( ARAT ) . Observations were continued for 32 weeks ( 24 weeks after the finish of ES or the control intervention phase ) . RESULTS The change in isometric strength of wrist extensors ( at an angle of 0 degrees extension ) was significantly greater in the ES group than the control group at both 8 and 32 weeks ( P=0.004 , P=0.014 by Mann Whitney U test ) . At week 8 the grasp and grip subscores of the ARAT increased significantly in the ES group compared with that in the control group ( P=0.013 and P=0.02 , respectively ) ; a similar trend was seen for the total ARAT score ( P=0.11 ) . In the subgroup of 33 patients with some residual wrist extensor strength at study entry ( moment at 0 degrees extension > 0 ) , the ARAT total score had increased at week 8 by a mean of 21.1 ( SD , 12.7 ) in the ES group compared with 10.3 ( SD , 9.0 ) in the control group ( P=0.024 , Mann Whitney U test ) ; however , at 32 weeks the differences between these 2 subgroups were no longer statistically significant . CONCLUSIONS ES of the wrist extensors enhances the recovery of isometric wrist extensor strength in hemiparetic stroke patients . Upper-limb disability was reduced after 8 weeks of ES therapy , with benefits most apparent in those with some residual motor function at the wrist . However , it is not clear how long the improvements in upper-limb disability are maintained after ES is discontinued Motor improvements in chronic stroke recovery accrue from coupled protocol s of bilateral movements and active neuromuscular stimulation . This experiment investigated coupled protocol s and within-limb transfer between distal and proximal joint combinations . The leading question focused on within-limb transfer of coupled protocol s on distal joints to a bimanual aim ing task that involved proximal joints . Twenty-six volunteers completed one of three motor recovery protocol s according to group assignments : ( 1 ) coupled bilateral involved concurrent wrist/finger movements on the unimpaired limb coupled with active stimulation on the impaired limb ; ( 2 ) unilateral/active stimulation involved neuromuscular electromyogram-triggered stimulation on the impaired wrist/fingers ; and ( 3 ) no protocol ( control group ) . During the pretest and posttest , subjects performed transverse plane target aim ing movements ( 29 cm ) with vision available . The coupled bilateral group showed positive intralimb transfer post-treatment when both arms moved simultaneously . During the posttest , the coupled bilateral group displayed improved movement time , higher peak limb velocity , less variability in peak velocity , and less percentage of total movement time in the deceleration phase than during the pretest . The evidence confirms that within-limb transfer from distal joint training to proximal joint combinations is viable and generalizable in chronic stroke rehabilitation . Moreover , these intralimb transfer findings extend the evidence favoring motor improvements for coupled bilateral protocol s during chronic stroke CONTEXT Single-site studies suggest that a 2-week program of constraint-induced movement therapy ( CIMT ) for patients more than 1 year after stroke who maintain some h and and wrist movement can improve upper extremity function that persists for at least 1 year . OBJECTIVE To compare the effects of a 2-week multisite program of CIMT vs usual and customary care on improvement in upper extremity function among patients who had a first stroke within the previous 3 to 9 months . DESIGN AND SETTING The Extremity Constraint Induced Therapy Evaluation ( EXCITE ) trial , a prospect i ve , single-blind , r and omized , multisite clinical trial conducted at 7 US academic institutions between January 2001 and January 2003 . PARTICIPANTS Two hundred twenty-two individuals with predominantly ischemic stroke . INTERVENTIONS Participants were assigned to receive either CIMT ( n = 106 ; wearing a restraining mitt on the less-affected h and while engaging in repetitive task practice and behavioral shaping with the hemiplegic h and ) or usual and customary care ( n = 116 ; ranging from no treatment after concluding formal rehabilitation to pharmacologic or physiotherapeutic interventions ) ; patients were stratified by sex , prestroke dominant side , side of stroke , and level of paretic arm function . MAIN OUTCOME MEASURES The Wolf Motor Function Test ( WMFT ) , a measure of laboratory time and strength-based ability and quality of movement ( functional ability ) , and the Motor Activity Log ( MAL ) , a measure of how well and how often 30 common daily activities are performed . RESULTS From baseline to 12 months , the CIMT group showed greater improvements than the control group in both the WMFT Performance Time ( decrease in mean time from 19.3 seconds to 9.3 seconds [ 52 % reduction ] vs from 24.0 seconds to 17.7 seconds [ 26 % reduction ] ; between-group difference , 34 % [ 95 % confidence interval { CI } , 12%-51 % ] ; P<.001 ) and in the MAL Amount of Use ( on a 0 - 5 scale , increase from 1.21 to 2.13 vs from 1.15 to 1.65 ; between-group difference , 0.43 [ 95 % CI , 0.05 - 0.80 ] ; P<.001 ) and MAL Quality of Movement ( on a 0 - 5 scale , increase from 1.26 to 2.23 vs 1.18 to 1.66 ; between-group difference , 0.48 [ 95 % CI , 0.13 - 0.84 ] ; P<.001 ) . The CIMT group achieved a decrease of 19.5 in self-perceived h and function difficulty ( Stroke Impact Scale h and domain ) vs a decrease of 10.1 for the control group ( between-group difference , 9.42 [ 95 % CI , 0.27 - 18.57 ] ; P=.05 ) . CONCLUSION Among patients who had a stroke within the previous 3 to 9 months , CIMT produced statistically significant and clinical ly relevant improvements in arm motor function that persisted for at least 1 year . Trial Registration clinical trials.gov Identifier : NCT00057018 Background and Purpose — Constraint-induced movement therapy ( CIMT ) is a rehabilitative strategy used primarily with the post-stroke population to increase the functional use of the neurologically weaker upper extremity through massed practice while restraining the lesser involved upper extremity . Whereas research evidence supports CIMT , limited evidence exists regarding the characteristics of individuals who benefit most from this intervention . The goal of this study was to investigate the potential of 5 measures to predict functional CIMT outcomes . Methods — A convenience sample of 55 individuals , > 6 months after stroke , was recruited that met specific inclusion /exclusion criteria allowing for individuals whose upper extremity was mildly to severely involved . They participated in CIMT 6 hours per day . Pretest , post-test , and follow-up assessment s were performed to assess the outcomes for the Wolf Motor Function Test ( WMFT ) . The potential predictors were minimal motor criteria ( active extension of the wrist and 3 fingers ) , active finger extension/grasp release , grip strength , Fugl – Meyer upper extremity motor score , and the Frenchay score . A step-wise regression analysis was used in which the potential predictors were entered in a linear regression model with simultaneous entry of the dependent variables ’ pretest score as the covariate . Two regressions models were determined for the dependent variable , for immediate post-test , and for follow-up post-test . Results — Finger extension was the only significant predictor of WMFT outcomes . Conclusions — When using finger extension/grasp release as a predictor in the regression equations , one can predict individual ’s follow-up scores for CIMT . This experiment provides the most comprehensive investigation of predictors of CIMT outcomes to date Background and Purpose — To compare a computerized arm trainer ( AT ) , allowing repetitive practice of passive and active bilateral forearm and wrist movement cycle , and electromyography-initiated electrical stimulation ( ES ) of the paretic wrist extensor in severely affected subacute stroke patients . Method — A total of 44 patients , 4 to 8 weeks after stroke causing severe arm paresis ( Fugl – Meyer Motor Score [ FM , 0 to 66 ] < 18 ) , were r and omly assigned to either AT or ES . All patients practice d 20 minutes every workday for 6 weeks . AT patients performed 800 repetitions per session with the robot and ES patients performed 60 to 80 wrist extensions per session . The primary outcome measure was the blindly assessed FM ( 0 to 66 ) , and the secondary measures were the upper limb muscle power ( Medical Research Council [ MRC ] sum , 0 to 45 ) and muscle tone ( Ashworth score sum , 0 to 25 ) , assessed at the beginning and end of treatment and at 3-month follow-up . Results — The AT group had a higher Barthel Index score at baseline , but the groups were otherwise homogenous . As expected , FM and MRC sum scores improved overtime in both groups but significantly more in the robot AT group . The initial Barthel Index score had no influence . In the robot AT group , FM score was 15 points higher at study end and 13 points higher at 3-month follow-up than the control ES group . MRC sum score was 15 points higher at study end and at 3-month follow-up compared with the control ES group . Muscle tone remained unchanged , and no side effects occurred . Conclusion — The computerized active arm training produced a superior improvement in upper limb motor control and power compared with ES in severely affected stroke patients . This is probably attributable to the greater number of repetitions and the bilateral approach Positional feedback ( PF ) and electrical stimulation were combined in a new treatment modality for facilitating wrist extension in stroke patients . Thirty adult hemiparetic patients lacking normal voluntary wrist extension were r and omly placed in control and study groups . The control group received conventional therapy while the study group received positional feedback stimulation training ( PFST ) in addition to conventional treatment . At the end of the 4-week program , study patients showed a 280 % increase in isometric extension torque when the wrist was positioned in 30 degrees of extension and 70 % increase when positioned in 30 degrees of flexion . Control patients showed no significant changes in torque . Study patients made an average 200 % gain in selective range of motion over their starting levels while controls made only a 50 % increase . Treatment using automated PFST equipment allows controlled repetitive isotonic exercise and facilitation of wrist extension without continuous one-on-one therapist/patient supervision Background and Purpose — Overcoming chronic hemiparesis from a cerebrovascular accident ( CVA ) can be challenging for many patients , especially after the first 12 months after the CVA . With the use of established motor control theories , the present study investigated electromyogram (EMG)-triggered neuromuscular stimulation and bilateral coordination training . Methods — Twenty-five CVA subjects volunteered to participate in this motor recovery protocol study . Subjects were r and omly assigned to 1 of 3 groups : ( 1 ) coupled protocol of EMG-triggered stimulation and bilateral movement ( n=10 ) ; ( 2 ) EMG-triggered stimulation and unilateral movement ( n=10 ) ; or ( 3 ) control ( n=5 ) . All participants completed 6 hours of rehabilitation during a 2-week period according to group assignments . Motor capabilities of the wrist and fingers were evaluated on Output:

Conclusion : No statistically significant differences in effects were found between EMG-NMES and usual care .

MS2_1shot447

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Summary The effectiveness of a new beta-D-galactosidase pellet formation in the treatment of lactose intolerance was studied . The encapsuled beta-D-galactosidase ( lactase ) pellets were first tested in vitro for their enzymatic activity within an environment simulating gastric conditions and subsequently within an environment simulating duodenal conditions . Effectiveness was measured by the % of glucose formed by hydrolysis of lactose . The pellets were found to retain their enzymatic activity in gastric pH conditions ( mean 69±1mg/dl glucose ) and were found to hydrolyse lactose in human duodenal fluid ( 106.35±1 mg/dl).Finally the effectiveness of the new lactase formation on glucose absorption was studied in 8 lactose intolerant subjects in a r and omized , double blind , crossover trial . After fasting , the subjects were given one capsule containing 100 u/ml beta-galactosidase ( i.e. 10 pellets of 10 u/ml each ) or one capsule containing placebo pellets , followed by 100 g lactose dissolved in water . The washout period between lactose challenges was one week . Plasma glucose concentrations were measured before and at intervals after the challenges and the subjects completed symptom question naires every eight hours for 24 hours . Results showed a statistically significant in plasma glucose levels 30 , 60 , 90 and 120 min after lactose ingestion ( repeated measures analysis of variance , p<0.01 ) . Subjective ratings of the severity of abdominal cramping , belching , flatulence , vomiting and diarrhoea were significantly decreased following ingestion of the lactase pellets and lactose ( no incidence of diarrhoea ) compared with after ingestion of placebo and lactose . The results of the study were considered to be very promising as the beta-D-galactosidase formulation ( which was produced at very low cost and with great ease ) resisted inactivation in the stomach , effectively transformed lactose to glucose in vivo and reduced symptoms of lactose intolerance OBJECTIVE To evaluate the efficacy of the addition to milk , 5 min and 10 h before its consumption , of a lactase obtained from Kluyveromyces lactis in lactose malabsorbers with intolerance . DESIGN Double-blind , placebo-controlled , crossover study . SETTING University Hospital . SUBJECTS In total , 11 male and 19 female ( aged from 18 to 65 y , mean age 43.3 y ) lactose malabsorbers with intolerance participated . INTERVENTIONS Each patient underwent three H(2 ) breath tests , in a r and om order . We used 400 ml of cow 's semiskimmed milk as substrate and a beta-galactosidase obtained from K. lactis . The test A was carried out adding to the milk the enzyme ( 3000 UI ) , 10 h before its consumption ; the test B was performed adding the beta-galactosidase ( 6000 UI ) 5 min before milk ingestion and the test C was made using placebo . We evaluated the maximum breath H(2 ) concentration , the cumulative H(2 ) excretion and a clinical score based on intolerance symptoms ( bloating , abdominal pain , flatulence and diarrhoea ) . RESULTS Our study showed a significant reduction of the mean maximum H(2 ) concentration after both test A ( 12.07 + /- 7.8 p.p.m . ) and test B ( 13.97 + /- 7.99 p.p.m . ) compared with test C ( 51.46 + /- 16.12 p.p.m . ) ( ANOVA F = 54.33 , P < 0.001 ) . Similarly , there was a significant reduction of the mean cumulative H(2 ) excretion after both test A ( 1428 + /- 1156 p.p.m . ) and test B ( 1761 + /- 966 p.p.m . ) compared with test C ( 5795 + /- 2707 p.p.m . ) ( ANOVA F = 31.46 , P < 0.001 ) . We also observed a significant reduction of the mean clinical score after both test A ( 0.36 + /- 0.55 ) and test B ( 0.96 + /- 0.85 ) compared with test C ( 3.7 + /- 0.79 ) ( ANOVA F = 106.81 , P < 0.001 ) . Moreover , with regard to the mean clinical score , there was a significant reduction after test A with respect to test B ( Bonferroni 's P = 0.03 ) . CONCLUSIONS Our study shows that in lactose malabsorbers with intolerance , the lactase obtained from K. lactis can represent a valid therapeutic strategy , with objective and subjective efficacy and without side effects Low-lactose milk was produced by incubating cow 's milk with yeast lactase . Sixteen lactose tolerant and 15 intolerant volunteers ingested 500 ml of the product twice daily for 1 month . During the testing period all subjects received on three occasions the same volume of unmodified milk in double-blind tests . Symptoms recorded throughout the study and for an additional 15 day base-line observation period were : diarrhea , abdominal pain and distention , flatulence , heartburn , and headache . Low-lactose milk acceptance was excellent . No significant differences were found between tolerants and intolerants during the base-line period and while ingesting low-lactose milk . By contrast , unmodified milk induced severe symptoms only in the intolerants . Availability of low-lactose milk and of its by-products allows consumption of greater volumes of this highly nutritious food by subjects with lactose intolerance with none or less symptoms compared to unmodified milk Acidophilus milk has been reported to help patients with irritable bowel syndrome by correcting the " imbalance of flora " and to be tolerated better by lactase-deficient subjects by providing bacterial lactase in the small intestine . In a double-blind r and omized study , 61 lactase-sufficient patients with irritable bowel syndrome each ingested 240 ml of milk three times a day for 2 wk and the same amount of acidophilus milk for an additional 2 wk . The degree of symptoms during the two milk-drinking periods was the same as during the control periods . Also , 18 lactase-deficient patients ingested unaltered milk for 1 wk and acidophilus milk for 1 additional wk . There was no difference in the degree of tolerance to the two varieties of milk . In summary , patients with irritable bowel syndrome were not helped by the ingestion of acidophilus milk , and lactase-deficient patients were as intolerant to acidophilus milk as to unaltered milk We conducted blinded , controlled crossover studies to determine the effect of daily lactose feeding on colonic adaptation and intolerance symptoms . The initial study with nine lactose maldigesters showed a threefold increase in fecal beta-galactosidase activity after 16 d of lactose feeding . To determine the effects of this adaptation on breath hydrogen and intolerance symptoms , 20 lactose-maldigesting adults were r and omly assigned to lactose or dextrose supplementation for 10 d ( days 1 - 10 ) , crossing over to the other period for days 12 - 21 . The sugar dosage was increased from 0.6 to 1.0 g.kg-1.d-1 , subdivided into three equal doses , by adjusting the dose every other day . Symptoms during lactose supplementation and comparison of symptoms during the lactose and dextrose feeding periods showed no significant differences . On days 11 and 22 , challenge doses of lactose ( 0.35 g/kg ) were administered after an overnight fast , and breath hydrogen and intolerance symptoms ( abdominal pain , flatulence , and diarrhea ) were carefully monitored for 8 h. Frequency of flatus passage and flatus severity ratings after the lactose challenge decreased 50 % when studied at the end of the lactose period compared with the dextrose period . The sum of hourly breath-hydrogen concentrations ( 1 - 8 h ) was significantly reduced after the lactose feeding period ( 9 + /- 38 ppm.h ) compared with after the dextrose period ( 385 + /- 52 ppm.h , P < 0.001 ) . We conclude that there is colonic adaptation to regular lactose ingestion and this adaptation reduces lactose intolerance symptoms The possible usefulness of low-lactose milk for those lactose-intolerant subjects who develop symptoms from milk consumption was investigated . In the first part of the study , 16 intolerant subjects ( blood glucose rise less than 25 mg/100 ml ) received low-lactose skim milk containing 15 g lactose ( 2.5 cups ) and 7.5 g lactose ( 2.5 cups ) , regular skim milk containing 30 g lactose ( 2.5 cups ) , and all three milks plus a small breakfast . The low lactose milks produced significantly fewer symptoms . The food given with the milk had no significant effect on symptomatic response . The second group of 17 subjects received 25 g lactose in water ( 250 ml ) , skim milk ( 500 ml ) and whole milk ( 500 ml ) ; 10 g lactose in lactose-reduced skim ( 500 ml ) and whole milk ( 500 ml ) and whole milk ( 500 ml ) ; and a placebo ( 250 ml ) . There was a significant positive relationship between amount of lactose consumed and symptom response . The form in which the lactose was administered ( e.g. , whole versus skim milk ) was not significantly related to symptoms . It is concluded that in a symptomatic subjects a significantly greater quantity of low-lactose milk than regular milks can be consumed The use of fermented dairy foods is common in areas of the world where lactase deficiency is prevalent . Recently , we have shown that the digestion of lactose from yogurt is enhanced as compared to that from milk . This enhanced digestion is apparently due to inherent B-galactosidase in yogurt which is active in the gastrointestinal tract after consumption of the yogurt . Furthermore , yogurt is well tolerated by lactase-deficient subjects result ing in little or no gastrointestinal distress . Since other fermented and microbial-containing dairy foods are consumed worldwide and may also contain some " lactase " activity , we chose to evaluate the digestion of lactose from three of these products : pasteurized yogurt , cultured milk ( buttermilk ) , and sweet acidophilus milk . Breath hydrogen techniques were used to evaluate lactose malabsorption in nine lactase-deficient subjects . The studies demonstrated that yogurt is unique among the products tested in enhancing the digestion of lactose . Furthermore , pasteurization of yogurt eliminated the enhanced digestion of lactose , reduced the inherent lactase activity of the yogurt by 10-fold and reduced cell counts by 100-fold . Interestingly , eight of nine subjects fed cultured milk experienced gastrointestinal distress , whereas all subjects fed pasteurized yogurt were symptom free , even though the amount of malabsorbed lactose was similar The relative effectiveness of five milk products with various levels of lactose reduction [ 0 % , 50 % , 80 % ( # 1 ) , 80 % ( # 2 ) , and 95 % ] was evaluated in six subjects with lactose malabsorption . Breath hydrogen was measured for 4 h after consumption of 300 mL of each product in a single-blind , r and omized design . The mean + /- SEM maximum breath-hydrogen rise ( ppm ) after the 0 % , 50 % , 80 % ( # 1 ) , 80 % ( # 2 ) , and 95 % lactose-reduced ( LR ) milks was 31 + /- 6 , 7 + /- 3 , 5 + /- 3 , 5 + /- 2 , and 8 + /- 3 , respectively . The difference between whole milk and the LR milks was statistically significant ( P less than 0.05 ) but there was no difference between any of the LR milks . Whole milk provoked symptoms in most subjects whereas 95 % LR milk produced none . Only one of six subjects reacted to the 50 % and 80 % LR milks . The results suggest that a 50 % level of lactose reduction in milk may be adequate to relieve the signs and symptoms of milk intolerance in the majority of healthy adults with lactose malabsorption Lactose digestion from and tolerance to flavored and frozen yogurts , ice cream , and ice milk were evaluated ( 20 g lactose/meal ) in lactase-deficient subjects by use of breath hydrogen techniques . Unflavored yogurt caused significantly less hydrogen production than milk ( 37 vs 185 delta ppm X h , n = 9 ) . Flavored yogurt was intermediate ( 77 delta ppm X h ) . Subjects were free of symptoms after consuming flavored and unflavored yogurts . Of seven commercial yogurts tested , all contained significant levels of microbial beta-galactosidase ( beta-gal ) . In addition , eight subjects were fed meals of milk , ice milk , ice cream , and frozen yogurts with and without cultures containing high levels of beta Output:

Moderate- quality evidence indicated that 12 to 15 g of lactose ( approximately 1 cup of milk ) is well tolerated by most adults . Evidence was insufficient that lactose-reduced solution or milk with a lactose content of 0 to 2 g , compared with greater than 12 g , is effective in reducing symptoms of lactose intolerance . Most individuals with presumed lactose intolerance or malabsorption can tolerate 12 to 15 g of lactose .

MS2_1shot448

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Controlled trials that use r and omized allocation are the best tool to control for bias and confounding in trials testing clinical interventions . Investigators must be sure to include information that is required by the reader to judge the validity and implication s of the findings in the reports of these trials . In part , complete reporting of trials will allow clinicians to modify their clinical practice to reflect current evidence toward the improvement of clinical outcomes . The consoli date d st and ards of reporting trials ( CONSORT ) statement was developed to assist investigators , authors , review ers , and editors on the necessary information to be included in reports of controlled clinical trials . The CONSORT statement is applicable to any intervention , including herbal medicinal products . Controlled trials of herbal interventions do not adequately report the information suggested in CONSORT . Recently , reporting recommendations were developed in which several CONSORT items were elaborated to become relevant and complete for r and omized controlled trials of herbal medicines . We expect that these recommendations will lead to more complete and accurate reporting of herbal trials . We wrote this explanatory document to outline the rationale for each recommendation and to assist authors in using them by providing the CONSORT items and the associated elaboration , together with examples of good reporting and empirical evidence , where available , for each . These recommendations for the reporting of herbal medicinal products presented here are open to revision as more evidence accumulates and critical comments are collected BACKGROUND Clear , transparent , and sufficiently detailed abstract s of conferences and journal articles related to r and omized controlled trials ( RCTs ) are important , because readers often base their assessment of a trial solely on information in the abstract . Here , we extend the CONSORT ( Consoli date d St and ards of Reporting Trials ) Statement to develop a minimum list of essential items , which authors should consider when reporting the results of a RCT in any journal or conference abstract . METHODS AND FINDINGS We generated a list of items from existing quality assessment tools and empirical evidence . A three-round , modified-Delphi process was used to select items . In all , 109 participants were invited to participate in an electronic survey ; the response rate was 61 % . Survey results were presented at a meeting of the CONSORT Group in Montebello , Canada , January 2007 , involving 26 participants , including clinical trialists , statisticians , epidemiologists , and biomedical editors . Checklist items were discussed for eligibility into the final checklist . The checklist was then revised to ensure that it reflected discussion s held during and subsequent to the meeting . CONSORT for Abstract s recommends that abstract s relating to RCTs have a structured format . Items should include details of trial objectives ; trial design ( e.g. , method of allocation , blinding/masking ) ; trial participants ( i.e. , description , numbers r and omized , and number analyzed ) ; interventions intended for each r and omized group and their impact on primary efficacy outcomes and harms ; trial conclusions ; trial registration name and number ; and source of funding . We recommend the checklist be used in conjunction with this explanatory document , which includes examples of good reporting , rationale , and evidence , when available , for the inclusion of each item . CONCLUSIONS CONSORT for Abstract s aims to improve reporting of abstract s of RCTs published in journal articles and conference proceedings . It will help authors of abstract s of these trials provide the detail and clarity needed by readers wishing to assess a trial 's validity and the applicability of its results Meta-analytic investigations sometimes use assessment s of research quality according to a formal protocol as a tool for improving research synthesis . We asked whether a particular quality scoring system could have a direct use in adjusting the summary estimates of a treatment difference . In an empirical study of the relation of quality scores to treatment differences in published meta-analyses of 7 groups of controlled r and omized clinical trials comprising 107 primary studies , we found no relation between treatment difference and overall quality score . We also found no relation between quality score and variation in treatment difference . The level of quality scores has increased at a rate of 9 % per decade for three decades , averaging 0.51 on a scale of 0 to 1 for the 1980s , and leaving much room for improvement . Nevertheless , attention to quality of studies by editors , review ers , and authors may be raising both the level of research done and quality of the reports Abstract Medical treatment is usually accompanied by a warning about potential side effects . While constituting an important component of informed consent , these warnings may themselves contribute to side effects via the placebo effect . We tested this possibility using a 2 × 2 between-subjects design . Under the guise of a trial of a new hypnotic , 91 undergraduates experiencing difficulty sleeping were allocated to receive a warning about a target side effect ( either increase or decrease in appetite , counterbalanced ) or no warning and then to receive placebo treatment or no treatment for one week . Placebo treatment led to significantly better sleep on almost all self-reported outcomes , suggesting a placebo effect for reported sleep difficulty . Actigraphy recordings were unaffected by treatment . There was a clear effect of the warning in that placebo treated participants who were warned about side effects were much more likely to report the target side effect than those not warned about side effects . Implication s for clinical practice are discussed CONTEXT Cognitive behavioral therapy ( CBT ) and hypnotic medications are efficacious for short-term treatment of insomnia , but few patients achieve complete remission with any single treatment . It is unclear whether combined or maintenance therapies would enhance outcome . OBJECTIVES To evaluate the added value of medication over CBT alone for acute treatment of insomnia and the effects of maintenance therapies on long-term outcome . DESIGN , SETTING , AND PATIENTS Prospect i ve , r and omized controlled trial involving 2-stage therapy for 160 adults with persistent insomnia treated at a university hospital sleep center in Canada between January 2002 and April 2005 . INTERVENTIONS Participants received CBT alone or CBT plus 10 mg/d ( taken at bedtime ) of zolpidem for an initial 6-week therapy , followed by extended 6-month therapy . Patients initially treated with CBT attended monthly maintenance CBT for 6 months or received no additional treatment and those initially treated with combined therapy ( CBT plus 10 mg/d of zolpidem ) continued with CBT plus intermittent use of zolpidem or CBT only . MAIN OUTCOME MEASURES Sleep onset latency , time awake after sleep onset , total sleep time , and sleep efficiency derived from daily diaries ( primary outcomes ) ; treatment response and remission rates derived from the Insomnia Severity Index ( secondary outcomes ) . RESULTS Cognitive behavioral therapy used singly or in combination with zolpidem produced significant improvements in sleep latency , time awake after sleep onset , and sleep efficiency during initial therapy ( all P<.001 ) ; a larger increase of sleep time was obtained with the combined approach ( P = .04 ) . Both CBT alone and CBT plus zolpidem produced similar rates of treatment responders ( 60 % [ 45/75 ] vs 61 % [ 45/74 ] , respectively ; P = .84 ) and treatment remissions ( 39 % [ 29/75 ] vs 44 % [ 33/74 ] , respectively ; P = .52 ) with the 6-week acute treatment , but combined therapy produced a higher remission rate compared with CBT alone during the 6-month extended therapy phase and the 6-month follow-up period ( 56 % [ 43/74 and 32/59 ] vs 43 % [ 34/75 and 28/68 ] ; P = .05 ) . The best long-term outcome was obtained with patients treated with combined therapy initially , followed by CBT alone , as evidence d by higher remission rates at the 6-month follow-up compared with patients who continued to take zolpidem during extended therapy ( 68 % [ 20/30 ] vs 42 % [ 12/29 ] ; P = .04 ) . CONCLUSION In patients with persistent insomnia , the addition of medication to CBT produced added benefits during acute therapy , but long-term outcome was optimized when medication is discontinued during maintenance CBT . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00042146 Background . The increased practice of traditional Chinese medicine ( TCM ) worldwide has raised concerns regarding herb-drug interactions . The purpose of our study is to analyze the concurrent use of Chinese herbal products ( CHPs ) among Taiwanese insomnia patients taking hypnotic drugs . Methods . The usage , frequency of services , and CHP prescribed among 53,949 insomnia sufferers were evaluated from a r and om sample of 1 million beneficiaries in the National Health Insurance Research Data base . A logistic regression method was used to identify the factors that were associated with the coprescription of a CHP and a hypnotic drug . Cox proportional hazards regressions were performed to calculate the hazard ratios ( HRs ) of hip fracture between the two groups . Results . More than 1 of every 3 hypnotic users also used a CHP concurrently . Jia-Wei-Xiao-Yao-San ( Augmented Rambling Powder ) and Suan-Zao-Ren-Tang ( Zizyphus Combination ) were the 2 most commonly used CHPs that were coadministered with hypnotic drugs . The HR of hip fracture for hypnotic-drug users who used a CHP concurrently was 0.57-fold ( 95 % CI = 0.47–0.69 ) that of hypnotic-drug users who did not use a CHP . Conclusion . Exploring potential CHP-drug interactions and integrating both healthcare approaches might be beneficial for the overall health and quality of life of insomnia sufferers PURPOSE Drug utilization studies are important for the optimization of drug therapy and have received a great attention in recent years . Most of the information on drug use patterns has been derived from studies in modern Western medicines ; however , studies regarding the drug utilization of traditional Chinese medicine ( CM ) are few . The present study was the first clinical research to evaluate the drug utilization patterns of Chinese herbal medicines in a general hospital in Taiwan . METHODS Data were collected prospect ively from the patients attending the Traditional Medicine Center of Taipei Veteran General Hospital under CM drug treatments . The study was carried out over a period of 1 year , from January 2002 to December 2002 . Core drug use indicators , such as the average number of drugs per prescriptions , the dosing frequency of prescriptions , and the most common prescribed CM herbs and formulae were evaluated . The primary diagnosis and the CM drugs prescribed for were also revealed . All data were analyzed by descriptive statistics . RESULTS A total of 10 737 patients , representing 52 255 CM drugs , were screened during the study period . Regarding the prescriptions , the average number of drugs per prescription was 4.87 and 37.21 % of prescriptions were composed by five drugs . Most of prescriptions ( 91.38 % ) were prescribed for three times a day . The most often prescribed Chinese herb was Hong-Hwa ( 5.76 % ) and the most common Chinese herbal formula was Jia-Wey-Shiau-Yau-San ( 3.80 % ) . The most frequent main diagnosis was insomnia ( 15.58 % ) , followed by menopause ( 5.22 % ) and constipation ( 5.09 % ) . CONCLUSION The survey revealed the drug use pattern of CMs in a general hospital . The majority of CM prescriptions were composed by 3 - 6 drugs and often prescribed for three times a day . Generally , the rational drug uses of CM drugs were provided with respect to the various diagnoses OBJECTIVE To subjectively and objective ly assess the effect of Jiawei Xiaoyao Powder ( JXYP ) on sleep in patients with psychological stress insomnia . METHHODS : A r and omized controlled study was conducted in 33 patients with psychological stress insomnia . They were assigned to 4 groups , 4 in the TCM group treated with JXYP , 5 in the Western medicine ( WM ) group treated with Estazolam , 9 in the integrated medicine ( IM ) group treated with JXYP plus Estazolam , and 10 in the control group treated with placebo . Quality of sleep in patients was assessed subjectively and objective ly before treatment and 6 weeks after treatment by Pittsburgh sleep quality index ( PSQI ) , self-rating scale of sleep ( SRSS ) and polysomnography ( PSG ) , respectively . RESULTS Subjective assessment on sleep showed that after 6-week treatment , the scores of PSQI and SRSS remarkably reduced in the TCM , IM and control groups ( P < 0.05 ) , while the decrease was insignificant in the WM group ( P > 0.05 ) , but no significant difference between groups was shown . The objective assessment by PSG showed that no significant change was found after treatment in parameters of total sleep time ( TST ) , sleep time of phase 1 and 2 , slow wave phase , rapid-eye-movement ( REM ) phase , sleep latency , REM sleep latency , also in long waking and short waking times in all group ( P > 0.05 ) , but a significant increase of sleep efficacy ( P < 0.05 ) and an increasing trend of TST ( P > 0.05 ) were shown in the IM group , and an increasing trend of both in the TCM group ( P > 0.05 ) . CONCLUSION JXYP , combined with or without Estazolam , can improve the quality of sleep subjectively , and the combination of the two could enhance the efficacy of sleep in patients with psychological stress insomnia ETHNOPHARMACOLOGICAL RELEVANCE Wuling Capsule is a single herbal formula from mycelia of precious Xylaria nigripes ( Kl . ) Sacc and its pharmacological function have a tranquilizing effect on the central nervous system . The aim of the study to evaluate the efficacy and safety of Wuling capsule in treatment of insomnia . MATERIAL S AND METHODS We performed a multicenter , r and omized Output:

Overall , oral CHM used as a monotherapy or as an adjunct to conventional therapies appears safe , and it may improve subjective sleep in people with insomnia . However , the typical effect of CHM for insomnia can not be determined due to heterogeneity .

MS2_1shot449

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Background Prospect i ve memory ( PM ) denotes the ability to remember to perform actions in the future . It has been argued that st and ard laboratory paradigms fail to capture core aspects of PM . Methodology /Principal Findings We combined functional MRI , virtual reality , eye-tracking and verbal reports to explore the dynamic allocation of neurocognitive processes during a naturalistic PM task where individuals performed err and s in a realistic model of their residential town . Based on eye movement data and verbal reports , we modeled PM as an iterative loop of five sustained and transient phases : intention maintenance before target detection ( TD ) , TD , intention maintenance after TD , action , and switching , the latter representing the activation of a new intention in mind . The fMRI analyses revealed continuous engagement of a top-down fronto-parietal network throughout the entire task , likely subserving goal maintenance in mind . In addition , a shift was observed from a perceptual ( occipital ) system while search ing for places to go , to a mnemonic ( temporo-parietal , fronto-hippocampal ) system for remembering what actions to perform after TD . Updating of the top-down fronto-parietal network occurred at both TD and switching , the latter likely also being characterized by frontopolar activity . Conclusion / Significance Taken together , these findings show how brain systems complementary interact during real-world PM , and support a more complete model of PM that can be applied to naturalistic PM tasks and that we named PROspect i ve MEmory DYnamic ( PROMEDY ) model because of its dynamics on both multi-phase iteration and the interactions of distinct neurocognitive networks Memories are of the past but for the future , enabling individuals to implement intended plans and actions at the appropriate time . Prospect i ve memory is the specific ability to remember and execute an intended behavior at some design ated point in the future . Although sleep is well-known to benefit the consolidation of memories for past events , its role for prospect i ve memory is still not well understood . Here , we show that sleep as compared to wakefulness after prospect i ve memory instruction enhanced the successful execution of prospect i ve memories two days later . We further show that sleep benefited both components of prospect i ve memory , i.e. to remember that something has to be done ( prospect i ve component ) and to remember what has to be done ( retrospective component ) . Finally , sleep enhanced prospect i ve remembering particularly when attentional re sources were reduced during task execution , suggesting that subjects after sleep were able to recruit additional spontaneous-associative retrieval processes to remember intentions successfully . Our findings indicate that sleep supports the maintenance of prospect i ve memory over time by strengthening intentional memory representations , thus favoring the spontaneous retrieval of the intended action at the appropriate time BACKGROUND Recent findings suggest that there may be a relationship between excessive daytime sleepiness ( EDS ) and cognitive deficits . This study aims to determine to what extent EDS is predictive of cognitive impairment in an elderly population . METHODS A total of 1026 individuals 60 years or older representative of the general population living in the metropolitan area of Paris , France , were interviewed by telephone using the Sleep-EVAL expert system . To find these individuals , 7010 r and omly selected households were called : 1269 had at least 1 household member in this age range ( participation rate , 80.9 % ) . In addition to Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition , and International Classification of Sleep Disorders diagnoses , the system administered to participants the Psychological General Well-being Schedule , the Cognitive Difficulties Scale ( MacNair-R ) , and an independent living scale . RESULTS Excessive daytime sleepiness was reported by 13.6 % of the sample , with no significant difference among age groups . Compared with nonsleepy participants , those with EDS were at increased risk of cognitive impairment on all the dimensions of the MacNair-R scale after controlling for age , sex , physical activity , occupation , organic diseases , use of sleep or anxiety medication , sleep duration , and psychological well-being . The odd ratios were 2.1 for attention-concentration deficits , 1.7 for praxis , 2.0 for delayed recall , 2.5 for difficulties in orientation for persons , 2.2 for difficulties in temporal orientation , and 1.8 for prospect i ve memory . CONCLUSIONS Among elderly individuals in the general population , EDS is an important risk factor for cognitive impairment . A complaint of EDS by an elderly patient should signal the possibility of an underlying cognitive impairment in need of evaluation Time-based prospect i ve memory ( TBPM ) is required when it is necessary to remember to perform an action at a specific future point in time . This type of memory has been found to be particularly sensitive to ageing , probably because it requires a self-initiated response at a specific time . In this study , we sought to examine the involvement of temporal processes in the time monitoring strategy , which has been demonstrated to be a decisive factor in TBPM efficiency . We compared the performance of young and older adults in a TBPM task in which they had to press a response button every minute while categorising words . The design allowed participants to monitor time by checking a clock whenever they decided . Participants also completed a classic time-production task and several executive tasks assessing inhibition , updating and shifting processes . Our results confirm an age-related lack of accuracy in prospect i ve memory performance , which seems to be related to a deficient strategic use of time monitoring . This could in turn be partially explained by age-related temporal deficits , as evidence d in the duration production task . These findings suggest that studies design ed to investigate the age effect in TBPM tasks should consider the contribution of temporal mechanisms The aim of the present study was to deepen knowledge about the effect of a lowered vigilance state on time-based prospect i ve memory ( TBPM ) performance . For this purpose 2 TBPM tasks ( primary and interpolated ) , which shared a portion of the retention interval , and 3 reasoning tasks , as ongoing activities , were administered after total sleep deprivation and in a regular sleep condition . The results showed a detrimental effect of sleep deprivation on prospect i ve memory performance and a partial dissociation between clock-checking behavior and time estimation for prospect i ve compliance . This study clearly indicates that total sleep deprivation im- pairs the ability to complete multiple prospect i ve task assignments in a timely fashion . Results are discussed suggesting the existence of different mechanisms involved in time monitoring and other cognitive functions underlying TBPM performance Prospect i ve memory is defined as remembering to do something at a particular moment in the future and may be modulated by sleep . Here , we investigated whether multiple nights of partial sleep deprivation would affect the successful retrieval of intentions . Fifty-nine adolescents ( mean age ± SD : 16.1 ± 0.6 years ) were instructed to remember to press specific keys in response to the target words presented during a semantic categorization task in the future . Their memory was tested after five nights of either 5-h ( sleep restriction group ) or 9-h time-in-bed ( control group ) . The average percentage of target words correctly responded to was small and did not significantly differ between the two groups ( mean ± SEM for the sleep restriction group : 15.52 ± 6.61 % ; the control group : 23.33 ± 7.48 % , p = 0.44 ) . Thus , after the extended retention interval , prospect i ve remembering was poor and did not appear to be affected by post-learning sleep restriction . These findings suggest a temporal boundary beyond which intentions fall below requisite levels of activation , potentially masking any benefits for retrieval conferred by sleep OBJECTIVE The relationship between insomnia symptoms and cognitive performance is unclear , particularly at the population level . We conducted the largest examination of this association to date through analysis of the UK Biobank , a large population -based sample of adults aged 40 - 69 years . We also sought to determine associations between cognitive performance and self-reported chronotype , sleep medication use and sleep duration . METHODS This cross-sectional , population -based study involved 477,529 participants , comprising 133,314 patients with frequent insomnia symptoms ( age : 57.4 ± 7.7 years ; 62.1 % female ) and 344,215 controls without insomnia symptoms ( age : 56.1 ± 8.2 years ; 52.0 % female ) . Cognitive performance was assessed by a touchscreen test battery probing reasoning , basic reaction time , numeric memory , visual memory , and prospect i ve memory . Adjusted models included relevant demographic , clinical , and sleep variables . RESULTS Frequent insomnia symptoms were associated with cognitive impairment in unadjusted models ; however , these effects were reversed after full adjustment , leaving those with frequent insomnia symptoms showing statistically better cognitive performance over those without . Relative to intermediate chronotype , evening chronotype was associated with superior task performance , while morning chronotype was associated with the poorest performance . Sleep medication use and both long ( > 9 h ) and short ( < 7 h ) sleep duration s were associated with impaired performance . CONCLUSIONS Our results suggest that after adjustment for potential confounding variables , frequent insomnia symptoms may be associated with a small statistical advantage , which is unlikely to be clinical ly meaningful , on simple neurocognitive tasks . Further work is required to examine the mechanistic underpinnings of an apparent evening chronotype advantage in cognitive performance and the impairment associated with morning chronotype , sleep medication use , and sleep duration extremes Experimental data indicate a role for the prefrontal cortex in mediating normal sleep physiology , dreaming and sleep-deprivation phenomena . During nonr and om-eye-movement ( NREM ) sleep , frontal cortical activity is characterized by the highest voltage and the slowest brain waves compared to other cortical regions . The differences between the self-awareness experienced in waking and its diminution in dreaming can be explained by deactivation of the dorsolateral prefrontal cortex during REM sleep . Here , we propose that this deactivation results from a direct inhibition of the dorsolateral prefrontal cortical neurons by acetylcholine , the release of which is enhanced during REM sleep . Sleep deprivation influences frontal executive functions in particular , which further emphasizes the sensitivity of the prefrontal cortex to sleep In daily life , we often need to remember to perform an action after , or at , a specific period of time ( e.g. , take pizza out of oven in 15 minutes ) . Surprisingly , little is known about the neural mechanisms that support this form of memory , termed time-based prospect i ve memory ( PM ) . Here we pioneer an fMRI paradigm that enables examination of both sustained and transient processes engaged during time-based PM . Participants were scanned while performing a dem and ing on-going task ( n-back working memory ) , with and without an additional time-based PM dem and . During the PM condition participants could access a hidden clock with a specific button-press response , while in the control condition , pseudo-clocks r and omly appeared and were removed via the same response . Analyses tested for sustained activation associated with the PM condition , and also transient activation associated with clock-checks and the PM target response . Contrary to prior findings with event-based PM ( i.e. , remembering to perform a future action when a specific event occurs ) , no sustained PM-related activity was observed in anterior prefrontal cortex ( aPFC ) or elsewhere in the brain ; instead , transient clock-related activity was observed in this region . Critically , the activation was anticipatory , increasing before clock-check responses . Anticipatory activity prior to the PM target response was weaker in aPFC , but strong in pre-Supplementary Motor Area ( pre-SMA ; relative to clock-check responses ) , suggesting a functional double dissociation related to volitional decision-making . Together , the results suggest that aPFC-activity dynamics during time-based PM reflect a distinct transient monitoring process , enabling integration of the PM intention with current temporal information to facilitate scheduling of upcoming PM-related actions On a daily basis we form numerous intentions to perform specific actions . However , we often have to delay the execution of intended actions while engaging in other dem and ing activities . Previous research has shown that patterns of activity in human prefrontal cortex ( PFC ) can reveal our current intentions . However , two fundamental questions have remained unresolved : ( a ) how does the PFC encode information about future tasks while we are busy engaging in other activities , and ( b ) how does the PFC enable us to commence a stored task at the intended time ? Here we investigate how the brain stores and retrieves future intentions during occupied delays , i.e. while a person is busy performing a different task . For this purpose , we conducted a neuroimaging study with a time-based prospect i ve memory paradigm . Using multivariate pattern classification and fMRI we show that during an occupied delay , activity patterns in the anterior PFC encode the content of ' what ' subjects intend to do next , and ' when ' they intend to do it . Importantly , distinct anterior PFC regions store the ' what ' and ' when ' components of future intentions during occupied maintenance and self-initiated retrieval . These results show a role for anterior PFC activity patterns in storing future action plans and ensuring their timely retrieval STUDY OBJECTIVES To evaluate the effect of sleep deprivation on time-based prospect i ve memory performance , that is , realizing delayed intentions at an appropriate time in the future ( e.g. , to take a medicine in 30 minutes ) . DESIGN Between-subjects experimental design . The experimental group underwent 24 h of total sleep deprivation , and the control group had a regular sleep-wake cycle . Participants were tested at 08:00 . SETTING S Laboratory . PARTICIPANTS Fifty healthy young adults ( mean age 22 ± 2.1 , 31 female ) . INTERVENTIONS 24 h of total sleep deprivation . MEASUREMENTS AND RESULTS Participants were monitored by wrist actigraphy for 3 days before the experimental session . The following cognitive tasks were administered : one time-based prospect i ve memory task and 3 reasoning tasks as ongoing activity . Objective and subjective vigilance was assessed by the psychomotor vigilance task and a visual analog scale , respectively . To measure the time-based prospect i ve memory task we assessed compliance and clock checking behavior ( time monitoring ) . Sleep deprivation negatively affected time-based prospect i ve memory compliance ( P < 0.001 ) , objective vigil Output:

In contrast , the benefits of sleep are significantly greater when the likelihood of spontaneous retrieval is high ( d = 0.94 , CI95 = 0.44 - 1.44 ) versus low ( d = 0.45 , CI95 = -0.02 - 0.93 ) , suggesting that sleep may leverage on spontaneous retrieval processes to improve PM .

MS2_1shot450

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Objective Betahistine is a histamine H1-receptor agonist and H3-receptor antagonist that is administered to treat Menière ’s disease . Despite widespread use , its pharmacological mode of action has not been entirely eluci date d. This study investigated the effect of betahistine on guinea pigs at dosages corresponding to clinical ly used doses for cochlear microcirculation . Methods Thirty healthy Dunkin-Hartley guinea pigs were r and omly assigned to five groups to receive betahistine dihydrochloride in a dose of 1,000 mg/kg b. w. ( milligram per kilogram body weight ) , 0.100 mg/kg b. w. , 0.010 mg/kg b. w. , 0.001 mg/kg b. w. in NaCl 0.9 % or NaCl 0.9 % alone as placebo . Cochlear blood flow and mean arterial pressure were continuously monitored by intravital fluorescence microscopy and invasive blood pressure measurements 3 minutes before and 15 minutes after administration of betahistine . Results When betahistine was administered in a dose of 1.000 mg/kg b. w. cochlear blood flow was increased to a peak value of 1.340 arbitrary units ( SD : 0.246 ; range : 0.933–1.546 arb . units ) compared to baseline ( p<0.05 ; Two Way Repeated Measures ANOVA/Bonferroni t-test ) . The lowest dosage of 0.001 mg/kg b. w. betahistine or NaCl 0.9 % had the same effect as placebo . Nonlinear regression revealed that there was a sigmoid correlation between increase in blood flow and dosages . Conclusions Betahistine has a dose-dependent effect on the increase of blood flow in cochlear capillaries . The effects of the dosage range of betahistine on cochlear microcirculation corresponded well to clinical ly used single dosages to treat Menière ’s disease . Our data suggest that the improved effects of higher doses of betahistine in the treatment of Menière ’s disease might be due to a corresponding increase of cochlear blood flow Thirty-seven patients suffering from vertigo associated with vertebrobasilar insufficiency participated in our prospect i ve , single-center , double-blind , comparative study . Patients were r and omly allocated to treatment with placebo ; betahistine ( 12 mg betahistine dimesylate , one tablet three times daily ) ; or the fixed combination of 20 mg cinnarizine and 40 mg dimenhydrinate ( one tablet three times daily ) for 4 weeks . The primary efficacy end point was the decrease of the mean vertigo score ( S(M ) ) , which was based on the patients ' assessment s of 12 individual vertigo symptoms after 4 weeks of treatment . Patients treated with the fixed combination showed significantly greater reductions of S(M ) as compared to patients receiving placebo ( p < .001 ) or the reference therapy betahistine ( p < .01 ) . The vestibulospinal parameter lateral sway ( Unterberger 's test ) improved to a significantly greater extent in patients taking the fixed combination as compared to those receiving placebo ( p < .001 ) . No serious adverse event was reported in any therapy group . The tolerability of the fixed combination was judged as very good or good by 91 % ( betahistine , 73 % ; placebo , 82 % ) . In conclusion , the fixed combination proved to be statistically more effective than the common antivertiginous drug betahistine in reducing vertebrobasilar insufficiency-associated vertigo symptoms A double-blind , placebo-controlled , clinical study was performed to assess the effects of oral betahistine hydrochloride ( Serc ) on mental impairment and physical disability in patients with established cerebrovascular disease . Fifty-three patients were admitted to the study during 18 months . Forty-five patients completed the study . They received either betahistine 24 mg daily or placebo for eight weeks . Clinical assessment s of general functional activity were done and a battery of nine mental function tests was administered pretreatment and at two-weekly intervals during therapy . The results were analysed statistically using distribution-free tests . Significant differences were demonstrated between betahistine and placebo at week 8 of treatment for associate learning , digit retention , general knowledge , orientation , sentence learning and simple arithmetic . These differences were consistently in favour of betahistine at or close to the 5 % level of significance . The results of the remaining mental function tests showed no significant differences between betahistine and placebo , but trends were in favour of the former . General functional activity assessment s also demonstrated that betahistine-treated patients were significantly better than those on placebo ( P less than or equal to 0.05 ) . No untoward side-effects were noted during the study Study question What is the long term efficacy of betahistine dihydrochloride on the incidence of vertigo attacks in patients with Meniere ’s disease , compared with placebo ? Methods The BEMED trial is a multicentre , double blind , r and omised , placebo controlled , three arm , parallel group , phase III , dose defining superiority trial conducted in 14 German tertiary referral centres ( for neurology or ear , nose , and throat ) . Adults aged 21 - 80 years ( mean age 56 years ) with definite unilateral or bilateral Meniere ’s disease were recruited from March 2008 to November 2012 . Participants received placebo ( n=74 ) , low dose betahistine ( 2 × 24 mg daily , ( n=73 ) ) , or high dose betahistine ( 3 × 48 mg daily , ( n=74 ) ) over nine months . The primary outcome was the number of attacks per 30 days , based on patients ’ diaries during a three month assessment period at months seven to nine . An internet based r and omisation schedule performed a concealed 1:1:1 allocation , stratified by study site . Secondary outcomes included the duration and severity of attacks , change in quality of life scores , and several observer-reported parameters to assess changes in audiological and vestibular function . Study answer and limitations Incidence of attacks related to Meniere ’s disease did not differ between the three treatment groups ( P=0.759 ) . Compared with placebo , attack rate ratios were 1.036 ( 95 % confidence interval 0.942 to 1.140 ) and 1.012 ( 0.919 to 1.114 ) for low dose and high dose betahistine , respectively . The overall monthly attack rate fell significantly by the factor 0.758 ( 0.705 to 0.816 ; P<0.001 ) . The population based , mean monthly incidence averaged over the assessment period was 2.722 ( 1.304 to 6.309 ) , 3.204 ( 1.345 to 7.929 ) , and 3.258 ( 1.685 to 7.266 ) for the placebo , low dose betahistine , and high dose betahistine groups , respectively . Results were consistent for all secondary outcomes . Treatment was well tolerated with no unexpected safety findings . Without a control group of patients who did not receive any intervention to follow the natural course of the disease , the placebo effect could not be accurately assessed and differentiated from spontaneous remission and fluctuation of symptoms . What this study adds Current evidence is limited as to whether betahistine prevents vertigo attacks caused by Meniere ’s disease , compared with placebo . The trial provides information on symptom relief on placebo intervention which is relevant for the design of future studies on potential disease modifying treatments in patients with Meniere ’s disease . Funding , competing interests , data sharing Support from the German Federal Ministry of Education and Research ( BMBF support code 01KG0708 ) . Potential competing interests have been reported in full at the end of the paper on thebmj.com . Data are available from the corresponding author ( Michael.Strupp@med.uni-muenchen.de ) or biostatistician ( mansmann@ibe.med.uni-muenchen.de ) . Study registration EudraCT no 2005 - 000752 - 32 ; IS RCT N no IS RCT N44359668 A double-blind , placebo-controlled , cross-over clinical trial was performed to assess the effect of betahistine hydrochloride ( Serc ) in Ménière 's disease . The diagnosis was based on paroxysmal attacks of rotational vertigo , with tinnitus , and a fluctuating sensori-neural deafness , together with the results of auditory and vestigular tests . Twenty-eight patients were admitted to the trial over 3 years . Twenty-two patients completed the trial . In total , they received betahistine 32 mg daily , for a period of 16 weeks , and placebo also for the same length of time , preceded in every case by a 4-week pre-treatment period . Daily symptom score cards were kept . There was a statistically significant improvement in favour of the drug with regard to vertigo , tinnitus and deafness . Vertigo was the most responsive symptom . No adverse reactions were observed Objective : The purpose of this study was to determine the prevalence and incidence of vestibular vertigo in the general population and to describe its clinical characteristics and associated factors . Methods : The neurotologic survey had a two-stage general population sampling design : nationwide modified r and om digit dialing sampling for participation in the German National Telephone Health Interview Survey 2003 ( response rate 52 % ) with screening of a r and om sample of 4,869 participants for moderate or severe dizziness or vertigo , followed by detailed neurotologic interviews developed through piloting and validation ( n = 1,003 , response rate 87 % ) . Diagnostic criteria for vestibular vertigo were rotational vertigo , positional vertigo , or recurrent dizziness with nausea and oscillopsia or imbalance . Vestibular vertigo was detected by our interview with a specificity of 94 % and a sensitivity of 88 % in a concurrent validation study using neurotology clinic diagnoses as an accepted st and ard ( n = 61 ) . Results : The lifetime prevalence of vestibular vertigo was 7.8 % , the 1-year prevalence was 5.2 % , and the incidence was 1.5 % . In 80 % of affected individuals , vertigo result ed in a medical consultation , interruption of daily activities , or sick leave . Female sex , age , lower educational level , and various comorbid conditions , including tinnitus , depression , and several cardiovascular diseases and risk factors , were associated with vestibular vertigo in the past year in univariate analysis . In multivariable analysis , only female sex , self-reported depression , tinnitus , hypertension , and dyslipidemia had an independent effect on vestibular vertigo . Conclusions : Vestibular vertigo is common in the general population , affecting more than 5 % of adults in 1 year . The frequency and health care impact of vestibular symptoms at the population level have been underestimated Objective . The purpose of this study is to evaluate the effects of betahistine in addition to Epley maneuver on the quality of life of patients with posterior semicircular canal benign paroxysmal positional vertigo ( BPPV ) of the canalithiasis type . Study Design . Double-blind , r and omized , controlled clinical trial . Setting . Academic university hospital . Subjects and Methods . Seventy-two patients were enrolled in the study . The first group was treated with Epley maneuver only . The second group received placebo drug 2 times daily for 1 week in addition to Epley maneuver , and the third group received 24 mg betahistine 2 times daily for 1 week in addition to Epley maneuver . The effectiveness of the treatments was assessed in each group as well as between them by analyzing and comparing data of 4 different vertigo symptom scales . Results . Epley maneuver , alone or combined with betahistine or placebo , was found to be very effective with a primary success rate of 86.2 % . The symptoms were significantly reduced in group 3 patients overall , and those patients younger or older than 50 years of age who had hypertension , with symptom onset < 1 month , and with attack duration of less than a minute did significantly better with the combination of betahistine 48 mg daily . Conclusion . Betahistine in addition to Epley maneuver is more effective than Epley maneuver alone or combined with placebo with regard to improvement of symptoms in certain patients . However , future clinical studies covering more patients to investigate the benefit of medical treatments in addition to Epley maneuver are needed OBJECTIVE To assess the prevalence of ear , nose and throat ( ENT ) symptoms experienced by individuals living in Scotl and , and their use of GP or hospital services for these problems . METHODS A cross-sectional postal self-completed question naire was sent to a r and om sample of 12,100 households throughout Scotl and . 15,788 individuals aged 14 + years living in the 7244 households who returned the question naire ( adjusted response rate 64.2 % ) participated in the study . RESULTS Roughly a fifth of respondents reported currently having hearing difficulties , including difficulty following conversations when there is background noise and hearing problems causing worry or upset ; few wore a hearing aid regularly . A fifth reported noises in head or ears ( tinnitus ) lasting more than five minutes . In the previous year , between 13 and 18 % of respondents reported persistent nasal symptoms or hayfever , 7 % sneezing or voice problems and 31 % had at least one episode of severe sore throat or tonsillitis . Nearly 21 % of all respondents reported ever having had dizziness in which things seemed to spin around the individual ; 29 Output:

Low quality evidence suggests that in patients suffering from vertigo from different causes there may be a positive effect of betahistine in terms of reduction in vertigo symptoms . Betahistine is generally well tolerated with a low risk of adverse events .

MS2_1shot451

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Objective : The underlying changes in biological processes that are associated with reported changes in mental and physical health in response to meditation have not been systematic ally explored . We performed a r and omized , controlled study on the effects on brain and immune function of a well‐known and widely used 8‐week clinical training program in mindfulness meditation applied in a work environment with healthy employees . Methods : We measured brain electrical activity before and immediately after , and then 4 months after an 8‐week training program in mindfulness meditation . Twenty‐five subjects were tested in the meditation group . A wait‐list control group ( N = 16 ) was tested at the same points in time as the meditators . At the end of the 8‐week period , subjects in both groups were vaccinated with influenza vaccine . Results : We report for the first time significant increases in left‐sided anterior activation , a pattern previously associated with positive affect , in the meditators compared with the nonmeditators . We also found significant increases in antibody titers to influenza vaccine among subjects in the meditation compared with those in the wait‐list control group . Finally , the magnitude of increase in left‐sided activation predicted the magnitude of antibody titer rise to the vaccine . Conclusions : These findings demonstrate that a short program in mindfulness meditation produces demonstrable effects on brain and immune function . These findings suggest that meditation may change brain and immune function in positive ways and underscore the need for additional research Recent studies suggest that months to years of intensive and systematic meditation training can improve attention . However , the lengthy training required has made it difficult to use r and om assignment of participants to conditions to confirm these findings . This article shows that a group r and omly assigned to 5 days of meditation practice with the integrative body – mind training method shows significantly better attention and control of stress than a similarly chosen control group given relaxation training . The training method comes from traditional Chinese medicine and incorporates aspects of other meditation and mindfulness training . Compared with the control group , the experimental group of 40 undergraduate Chinese students given 5 days of 20-min integrative training showed greater improvement in conflict scores on the Attention Network Test , lower anxiety , depression , anger , and fatigue , and higher vigor on the Profile of Mood States scale , a significant decrease in stress-related cortisol , and an increase in immunoreactivity . These results provide a convenient method for study ing the influence of meditation training by using experimental and control methods similar to those used to test drugs or other interventions ABSTRACT Stress is important in substance use disorders ( SUDs ) . Mindfulness training ( MT ) has shown promise for stress-related maladies . No studies have compared MT to empirically vali date d treatments for SUDs . The goals of this study were to assess MT compared to cognitive behavioral therapy ( CBT ) in substance use and treatment acceptability , and specificity of MT compared to CBT in targeting stress reactivity . Thirty-six individuals with alcohol and /or cocaine use disorders were r and omly assigned to receive group MT or CBT in an outpatient setting . Drug use was assessed weekly . After treatment , responses to personalized stress provocation were measured . Fourteen individuals completed treatment . There were no differences in treatment satisfaction or drug use between groups . The laboratory paradigm suggested reduced psychological and physiological indices of stress during provocation in MT compared to CBT . This pilot study provides evidence of the feasibility of MT in treating SUDs and suggests that MT may be efficacious in targeting stress BACKGROUND Research has shown that exposure to stress/negative affect and to alcohol cues can each increase alcohol craving and relapse susceptibility in alcohol-dependent individuals . However , whether the emotional and physiological states associated with stress-induced and alcohol cue-induced craving are comparable has not been well studied . Therefore , this study examined the craving , emotional , and physiological responses to stress and to alcohol cues in treatment-engaged , 4-week abstinent , alcohol-dependent individuals using analogous stress and alcohol cue imagery methods . METHOD Twenty treatment-seeking , alcohol-dependent participants ( 18 males/2 females ) were exposed to a brief 5-minute guided imagery procedure that involved imagining a recent personal stressful situation , a personal alcohol cue-related situation , and a neutral-relaxing situation , 1 imagery per session presented in r and om order . Alcohol craving , anxiety and emotion rating scales , cardiovascular measures , and salivary cortisol were compared across the 3 conditions . RESULTS Exposure to stress and to alcohol cues each produced significant increases in alcohol craving , anxiety , and negative emotions and decreases in positive emotions . Stress-induced alcohol craving was significantly correlated with increases in sadness , anger , and anxiety ratings , but alcohol cue-induced craving was associated with decreases in positive affect ( joy and neutral relaxed state ) and increases in anxiety and fear ratings . Furthermore , stress increased systolic and diastolic blood pressure responses , but significant increases in salivary cortisol were only observed in the alcohol cue condition . CONCLUSIONS Although both stress and alcohol cues produce increases in anxiety associated with alcohol craving , each produced a dissociable psychobiological state involving subjective emotional , cardiovascular , and cortisol responses . These data could have significant implication s for underst and ing the specific psychobiology associated with stress or alcohol cue exposure and their potential effects on alcohol relapse susceptibility ABSTRACT The current study is the first r and omized-controlled trial evaluating the feasibility and initial efficacy of an 8-week outpatient Mindfulness-Based Relapse Prevention ( MBRP ) program as compared to treatment as usual ( TAU ) . Participants were 168 adults with substance use disorders who had recently completed intensive inpatient or outpatient treatment . Assessment s were administered pre-intervention , post-intervention , and 2 and 4 months post-intervention . Feasibility of MBRP was demonstrated by consistent homework compliance , attendance , and participant satisfaction . Initial efficacy was supported by significantly lower rates of substance use in those who received MBRP as compared to those in TAU over the 4-month post-intervention period . Additionally , MBRP participants demonstrated greater decreases in craving , and increases in acceptance and acting with awareness as compared to TAU . Results from this initial trial support the feasibility and initial efficacy of MBRP as an aftercare approach for individuals who have recently completed an intensive treatment for substance use disorders Output:

They used a linguistic analysis method applied to participant-written stories of stress and found that the MBTC group used fewer negative words than the control group over all time points . Britton and colleagues , in the study : " The Contribution of Mindfulness Practice to a Multicomponent Behavioral Sleep Intervention Following Substance Abuse Treatment in Adolescents , " found that mindfulness practice was associated with improved sleep , psychological health and reduced substance use . Amaro and colleagues , in their study : " Addiction Treatment Intervention : An Uncontrolled Prospect i ve Pilot Study of Spiritual Self-Schema Therapy with Latina Women , " noted high rates of intervention acceptability , and positive changes in outcomes relevant to HIV prevention and recovery from addiction . Although conclusive data for mindfulness meditation based interventions as therapies for SUDs are lacking , the preliminary evidence reported in these and prior studies suggests their efficacy . The promise of mindfulness based therapies is supported by the consistency of positive results demonstrated across different study design s , intervention modalities , subject population s and addictive disorders treated ( 2 ) . Additional support for the potential efficacy of these interventions in SUDs can be drawn from the results of studies of other clinical conditions ; mindfulness based therapies have been shown effective or potentially effective for a variety of medical and mental health disorders , including stress , anxiety , depression , emotion dysregulation , avoidance coping,(7–12 ) all known risk factors for relapse in SUDs ( 13,14 ) . In this context , mindfulness meditation based interventions may be particularly helpful for patients with co-occurring substance use and mental health disorders ( " dual diagnosis " ) . In addition , mindfulness based interventions appear safe , satisfying to clients and may have long-lasting effects in the context of continued meditation practice ( 2,7 ) – all vital qualities of an " ideal " treatment .

MS2_1shot452

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Objective : To assess the clinical relevance of mean and minimum femorotibial joint space narrowing ( JSN ) for predicting future osteoarthritis related surgery in patients with knee osteoarthritis . Methods : 126 subjects with primary knee osteoarthritis were followed prospect ively for a mean eight years . Minimum and mean joint space width ( JSW ) were assessed from st and ard x rays at baseline and after a follow up of three years . The rate of knee osteoarthritis related surgery was recorded for the following five years . Results : After a mean follow up of eight years , 16 patients ( 12.7 % ) had received osteoarthritis related joint surgery . The areas under the curves ( AUC ) result ing from the receiver operating characteristic curve analyses for predicting osteoarthritis surgery were 0.73 ( p = 0.006 ) for minimum JSN and 0.55 ( p = 0.54 ) for mean JSN . The cut off for minimum JSN maximising sensitivity and specificity for predicting future surgery was a change of 0.7 mm or more in minimum joint space width over a period of three years . However , no meaningful differences were observed for cut off values between 0.5 and 0.8 mm The relative risk ( adjusted for age , body mass index , baseline symptoms , and baseline JSW ) of experiencing osteoarthritis related surgery during the eight year of follow up was 5.15 ( 95 % confidence interval , 1.70 to 15.60 ) ( p = 0.004 ) in patients with a minimum joint space narrowing of 0.7 mm or more during the first three years of the study . Conclusions : A cut off of 0.5 to 0.8 mm in minimum JSN , measured on st and ard x rays , reflects a clinical ly relevant progression in patients with knee osteoarthritis OBJECTIVE The failure to image the patellofemoral joint or the posterior knee compartment when evaluating persons for knee osteoarthritis may result in missed cases . While the skyline view has been recommended due to more reproducible assessment of the patellofemoral joint space , the lateral view may be easier to acquire and provides different information . We evaluated the sensitivity of different combinations of X-ray views ( anteroposterior and lateral ; anteroposterior and skyline ; all three views ) in 377 persons with knee symptoms who had all three views available and had a definite osteophyte on at least one view . RESULTS Of the different views , skylines had to be excluded most often because the image of the patellofemoral joint was technically unsatisfactory . In the remaining knees , adding either a lateral or a skyline view to an anteroposterior view yielded roughly equal and high sensitivity ( 94 - 97 % ) when compared with the gold st and ard of a positive X-ray on any of the three views . CONCLUSION As long as at least an anteroposterior view and one image of the patellofemoral joint is obtained ( either skyline or lateral ) , few cases with radiographic disease will be missed . For clinical or epidemiological studies the lateral view may be easier to acquire with high quality than the skyline view OBJECTIVE Flexion and erect st and ing radiographs were evaluated in the current study to compare their sensitivity in detecting articular cartilage wear . DESIGN Prospect i ve cohort study . SETTING A tertiary care hospital outpatient orthopedic clinic . PATIENTS All patients with osteoarthritis of the knee ages 40 to 75 scheduled for arthroscopic debridement between March 1995 and November 1997 were considered for the current study . INTERVENTION Radiographs were obtained 1 week preoperatively in both the 3-foot st and ing anteroposterior ( AP ) and a 45 degrees posteroanterior ( PA ) flexion weight-bearing projection . Joint space height was measured with a ruler in millimeters at the narrowest point of each compartment . All radiographs were assessed by two independent observers who were blinded to the arthroscopic findings and clinical symptoms of the subjects . MAIN OUTCOME MEASURES Prediction accuracy of each radiograph for severe Grade IV articular cartilage wear in tibio-femoral compartments . RESULTS One hundred fifty-two patients with a mean ( + /- SD ) age of 60.5+/-8.5 years were enrolled in the study . Fifty-one percent were female . Twelve patients were categorized as having severe lateral compartment articular chondropathy ( Grade IV ) at the time of arthroscopy . The lateral joint space height averaged 1.0+/-1.7 mm SD on the 45 degrees PA radiograph compared with 2.7+/-1.1 mm SD on the 3-foot st and ing AP view . Using a cutoff of 2 mm or less , the 45 degrees PA view was much more sensitive ( 83 % versus 42 % ) at correctly detecting the most severe chondropathy . Forty-one patients were classified with severe Grade IV medial compartment chondropathy at arthroscopy . There was little difference in the average joint space height measured by the 45 degrees PA view ( 1.4+/-1.4 mm SD ) or the 3-foot st and ing AP view ( 1.9+/-1.6 mm SD ) . A number of cutoff measures were evaluated , but no significant advantage could be found for either view in evaluating the medial compartment severity . CONCLUSIONS The bilateral 45 degrees PA is superior for detecting lateral compartment wear but offers no advantage on the medial side . This view should be considered as the screening radiograph of choice in evaluating osteoarthritis of the knee OBJECTIVE To compare quantitative estimates of change in joint space width ( JSW ) with semiquantitative ratings of the progression of joint space narrowing ( JSN ) with respect to sensitivity to change over time . METHODS 431 obese women 45 to 64 years old with unilateral radiographic knee osteoarthritis were r and omised to 30 months ' treatment with doxycycline 100 mg twice daily or placebo . Quantitative estimates of change in JSW in the medial tibiofemoral compartment from fluoroscopically assisted semiflexed AP radiographs were obtained at baseline and 16 and 30 months after r and omisation . Radiographic JSN was rated ( 0 - 3 scale ) in the same images by two readers using a st and ard atlas . Changes in overall severity of knee osteoarthritis were derived from gradings of conventional st and ing AP radiographs at baseline and 30 months , with blinding to treatment group and chronological order of examination . RESULTS Follow up radiographs were obtained from 381 subjects ( 88 % ) at 16 months and from 367 ( 85 % ) at 30 months . The treatment groups did not differ in the frequency of significant loss of JSW by dichotomous criteria ( > or = 0.5 mm , > or = 1.0 mm , > or = 20 % , or > or = 50 % of baseline JSW ) . Progressors and non-progressors , as defined by each of the dichotomous outcomes , differed significantly in mean value for quantitative measurement of change in JSW at 30 months ( p < or = 0.001 ) . CONCLUSIONS Quantitative and semiquantitative indicators of progression of osteoarthritis in fluoroscopically st and ardised radiographs of osteoarthritic knees are highly related , but the effect of doxycycline on articular cartilage thickness was more easily detected with quantitative measurements of change in JSW than with semiquantitative ratings of JSN OBJECTIVE To evaluate the effectiveness of using subchondral bone texture observed on a radiograph taken at baseline to predict progression of knee osteoarthritis ( OA ) over a 3-year period . METHODS A total of 138 participants in the Prediction of Osteoarthritis Progression study were evaluated at baseline and after 3 years . Fractal signature analysis ( FSA ) of the medial subchondral tibial plateau was performed on fixed flexion radiographs of 248 nonreplaced knees , using a commercially available software tool . OA progression was defined as a change in joint space narrowing ( JSN ) or osteophyte formation of 1 grade according to a st and ardized knee atlas . Statistical analysis of fractal signatures was performed using a new model based on correlating the overall shape of a fractal dimension curve with radius . RESULTS Fractal signature of the medial tibial plateau at baseline was predictive of medial knee JSN progression ( area under the curve [ AUC ] 0.75 , of a receiver operating characteristic curve ) but was not predictive of osteophyte formation or progression of JSN in the lateral compartment . Traditional covariates ( age , sex , body mass index , knee pain ) , general bone mineral content , and joint space width at baseline were no more effective than r and om variables for predicting OA progression ( AUC 0.52 - 0.58 ) . The predictive model with maximum effectiveness combined fractal signature at baseline , knee alignment , traditional covariates , and bone mineral content ( AUC 0.79 ) . CONCLUSION We identified a prognostic marker of OA that is readily extracted from a plain radiograph using FSA . Although the method needs to be vali date d in a second cohort , our results indicate that the global shape approach to analyzing these data is a potentially efficient means of identifying individuals at risk of knee OA progression Preoperatively predicting chondral damage is important . Weightbearing radiographs , including the st and ing antero- posterior and 45 ° flexion posteroanterior views traditionally have been used for this purpose . We wanted to determine if one radiograph had superior sensitivity or specificity in detecting arthroscopically confirmed Grade II chondromalacia ( mild arthritis ) . A st and ard prospect i ve st and ing radio- graphic protocol was design ed for all patients who presented to a sports medicine center with knee complaints . Patients who had subsequent arthroscopic surgery had their radio- graphs measured in a blinded manner for articular cartilage intervals in millimeters to detect joint-space narrowing . Intraarticular chondral damage was correlated with the radio- graphic findings . Three hundred forty-nine of a possible 411 ( 87 % ) patients during a 2-year period had both radiographs and subsequent arthroscopic grading of chondromalacia . This has been the largest study that correlated arthroscopic chondromalacia grade s with two commonly preferred weightbearing radiograph projections . Despite specificities greater than 90 % , the sensitivity was extremely low and neither st and ing radiograph was superior . Neither radiograph was useful in detecting Grade II chondral damage . Level of Evidence : Diagnostic study , Level I-1 ( testing of previously developed diagnostic criteria in series of consecutive patients -with universally applied reference “ gold ” st and ard ) . See the Guidelines for Authors for a complete description of levels of evidence We proposed to establish a system of assessing severity of chondropathy taking into account localization , size , and depth of cartilage lesions . The design of the study was prospect i ve and multicenter . The subjects were 755 patients who had undergone arthroscopy of the knee . Criteria for assessment of severity of chondropathy were as follows : ( a ) Physician 's overall assessment using a 100-mm-long Visual Analogue Scale , and ( b ) size , grade , and localization of cartilage lesions recorded on a diagram . We used multivariate parametric and nonparametric analyses . The analyses result ed in two systems of assessing severity of chondropathy : SFA scoring for the three compartments of the knee , which is a continuous variable , and SFA grading , which is a semiquantitative variable . These systems seem to be of clinical relevance . However , more studies are required to further vali date them and their capacity to detect changes in severity of chondropathy Twenty-seven patients with chronic knee pain were examined prospect ively using conventional radiography , radionuclide angiography , planar bone scintigraphy , and single-photon emission computed tomographic ( SPECT ) bone scintigraphy . When the results of subsequent arthroscopic examination of all three compartments of the knee were correlated with those of the noninvasive methods , SPECT bone scintigraphy was found to be most sensitive for evaluating the extent of osteoarthritis . Differences in detection sensitivity for articular cartilage damage and synovitis were greatest in the patellofemoral compartment . The frequency with which hyperemia was present in association with cartilage damage and synovitis indicates that osteoarthritis of the knee is capable of producing hyperemia and further implies that increased perfusion can not be used to distinguish with confidence between osteoarthritis and septic processes involving the knee . SPECT ( 1.00 ) and planar ( 0.91 ) bone scintigraphy were highly sensitive indicators of torn menisci in a subgroup of 14 patients , each having a prearthroscopic clinical diagnosis of a torn meniscus . This result suggests that for patients with chronic knee pain and clinical suggestion of a torn meniscus , bone scintigraphy has significant potential as a high-sensitivity , prearthroscopic screening examination OBJECTIVE To evaluate progression of joint space narrowing in radiographs of osteoarthritic ( OA ) knees imaged in both the st and ing anteroposterior ( AP ) and the Lyon schuss positions , using alternative methods to measure joint space width ( JSW ) . METHODS St and ing AP ( extended view ) and Lyon schuss ( posteroanterior [ PA ] view , with 20 - 30 degrees of flexion ) radiographic images of 58 OA knees were obtained twice ( at baseline and 2 years later ) . With both methods , Output:

The 45 ° flexion PA view showed a higher sensitivity than the st and ing AP view for detecting severe arthritis involving either the medial or lateral tibiofemoral compartment . There was no difference in the specificities for the 2 views . The direct comparison of the Kellgren-Lawrence and the JSN radiographic grading systems found no clinical difference between the 2 systems regarding the sensitivities , although the specificity was greater for the JSN system . However , as an inexpensive screening tool , the 45 ° flexion PA view is more sensitive than the st and ing AP view to detect severe tibiofemoral osteoarthritis . When evaluating the radiograph for severe osteoarthritis using either the Kellgren-Lawrence or JSN grading system , there is no clinical difference in the sensitivity between the 2 methods ; however , the JSN may be more specific for ruling in severe osteoarthritis in the medial compartment .

MS2_1shot453

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Purpose To assess whether there are changes on anthropometric and biochemical measures of adiposity in pre- and postmenopausal women and in the latter before and after 6 months treatment with 17β-estradiol plus drospirenone . Methods Twenty postmenopausal and 20 premenopausal women were enrolled in a prospect i ve comparative study . Postmenopausal women received 1 mg 17β-estradiol plus 2 mg drospirenone daily for 6 months . Measurements of body mass index ( BMI ) , waist/hip ratio and plasmatic levels of insulin , glucose , high-density lipoprotein ( HDL ) , low-density lipoprotein ( LDL ) , triglyceride , leptin , adiponectin , orexin-A , glucagon-like peptide-1 ( GLP-1 ) and ghrelin were performed in premenopausal ( group 1 ) and postmenopausal women and in the latter before ( group 2a ) and after ( group 2b ) 6 months treatment with 17β-estradiol plus drospirenone . Results No significant changes in BMI s , insulin and glucose were observed between group 1 and 2a ; and group 2a and 2b . GLP-1 levels were significantly increased in group 1 compared to group 2a ( p = 0.035 ) . Leptin levels were significantly increased ( p = 0.001 ) and GLP-1 levels were significantly decreased ( p = 0.021 ) in group 2b compared to group 2a . HDL was significantly decreased while LDL and triglyceride levels were significantly increased in group 2a compared to group 1 . ( p = 0.030 , p = 0.001 , p = 0.020 ; respectively ) LDL was significantly decreased ( p = 0.010 ) in group 2b compared to group 2a . GLP-1 had a positive correlation with orexin-A ( p < 0.001 , r = 0.520 ) and negative correlation with leptin ( p = 0.008 , r = −0.345 ) . Conclusion Leptin was significantly higher and GLP-1 was significantly lower in women receiving 17β-estradiol plus drospirenone treatment . GLP-1 levels were significantly lower after the menopause compared to premenopausal levels . Orexin-A and GLP-1 were positively correlated Hypocretin ( orexin ) peptides are involved in the regulation of energy balance and pituitary hormone release . Narcolepsy is a sleep disorder characterized by disruption of hypocretin neurotransmission . Pituitary LH secretion is diminished in hypocretin-deficient animal models , and intracerebroventricular administration of hypocretin-1 activates the hypothalamo-pituitary-gonadal axis in rats . We evaluated whether hypocretin deficiency affects gonadotropin release in humans . To this end , we deconvolved 24-h serum concentrations of LH and FSH in seven hypocretin-deficient narcoleptic males ( N ) and seven controls ( C ) matched for age , body mass index , and sex . Basal plasma concentrations of testosterone , estradiol , and sex hormone-binding globulin were similar in both groups . Mean 24-h LH concentration was significantly lower in narcolepsy patients [ 3.0 + /- 0.4 ( N ) vs. 4.2 + /- 0.3 ( C ) U/l , P = 0.01 ] , which was primarily due to a reduction of pulsatile LH secretion [ 23.5 + /- 1.6 ( N ) vs. 34.3 + /- 4.9 ( C ) U.l(-1).24 h(-1 ) , P = 0.02 ] . The orderliness of LH and FSH secretion , quantitated by the approximate entropy statistic , was greater in patients than in controls . In contrast , all other features of FSH release were similar in narcoleptic and control groups . Also , LH and FSH secretions in response to intravenous administration of 100 microg of GnRH were similar in patients and controls . These data indicate that endogenous hypocretins are involved in the regulation of the hypothalamo-pituitary-gonadal axis activity in humans . In particular , reduced LH release in the face of normal pituitary responsivity to GnRH stimulation in narcoleptic men suggests that hypocretins promote endogenous GnRH secretion Abstract Aim : In the current study , we aim ed to investigate whether serum orexin-A ( OXA ) levels are different in polycystic ovary syndrome ( PCOS ) subjects . Material s and methods : Thirty-six women with PCOS and 40 healthy , age and body mass index-matched controls were included in the prospect i ve cross-sectional study . All subjects underwent venous blood draws during the early follicular phase after overnight fasting . Serum OXA levels were measured with an enzyme immunoassay ( EIA ) . The relationships between the serum OXA levels and the anthropometric and metabolic parameters were also assessed . Results : The serum OXA levels were lower in the women with PCOS compared to the control group . The serum OXA levels were correlated negatively with systolic blood pressure , the Ferriman-Gallway score and LH and free testosterone levels . Conclusion : Our results indicate that serum OXA levels decrease in the serum of women with PCOS STUDY OBJECTIVES Obesity is a common feature of narcolepsy . In addition , an increased occurrence of non-insulin dependent diabetes has been reported . So far , it is not known whether glucose metabolism in narcolepsy is disturbed due to , or independently of obesity . DESIGN Case-control study . SETTING Sleep medicine clinic at a research institute . PATIENTS We studied 17 patients with narcolepsy/cataplexy compared to 17 healthy controls matched for age , sex , and body mass index ( BMI ) . INTERVENTIONS A 75-g oral glucose tolerance test was performed . MEASUREMENTS Glucose tolerance was determined by computing plasma glucose curve following oral glucose challenge for 240 minutes ; insulin sensitivity and insulin secretion by homeostasis model assessment and minimal model analysis . RESULTS St and ard outcome measures and indices of the oral glucose tolerance test did not differ between the patient group and the group of control subjects . CONCLUSIONS In this study , no clinical ly relevant pathologic findings in the glucose metabolism of narcoleptic patients compared to weight matched controls were found . Thus , narcolepsy is unlikely to be a risk factor per se for impaired glucose tolerance or diabetes OBJECTIVE Alterations in sleep quality and metabolism during menopause are improved by menopausal hormone therapy ( MHT ) . The mechanisms mediating these effects remain unclear . Orexin A ( OxA ) is a neuro-peptide that regulates sleep/wakefulness , food intake and metabolism . This study examined changes in plasma OxA levels during and after treatment in women from the Kronos Early Estrogen Prevention Study ( KEEPS ) . METHODS KEEPS r and omized women within three years of menopause to : oral conjugated equine estrogen ( o-CEE , 0.45mg/day ) , transdermal 17β estradiol ( t-E2 , 50μg/day ) , or placebo pills and patches for four years . Plasma OxA levels were measured by enzyme immunoassays in fasting blood sample s collected annually from KEEPS participants at Mayo Clinic during and three years after MHT . Changes in menopausal symptoms and plasma OxA levels were assessed for treatment differences . RESULTS During treatment , OxA levels increased more in women r and omized to o-CEE compared with the other groups . Women r and omized to either form of MHT demonstrated smaller increases in BMI than those on placebo . Insomnia severity decreased similarly among treatment groups . However , neither changes in sleep nor changes in BMI correlated with changes in plasma OxA levels . Changes in waist circumference correlated positively with changes in plasma OxA levels three years after discontinuation of study treatments . CONCLUSIONS Although OxA levels increased only in women r and omized to o-CEE , these changes did not correlate with changes in sleep quality or BMI . The modest correlation of OxA levels with waist circumference once study treatments were discontinued suggests that OxA may be modulated through multiple intermediary pathways affected by metabolites of 17β-estradiol . Clinical Trial Registration for KEEPS : NCT00154180 AIMS To investigate the association between serum orexin concentrations and insulin resistance/sensitivity in a sample of patients with type 2 diabetes mellitus , and to study the effects of anti-hyperglycemic treatment on orexin concentrations over three months . METHODS This study was design ed as a r and omized , open-label , clinical trial . Before allocation , sixty medication-naïve , newly-diagnosed , type 2 diabetes patients underwent a 75 g oral glucose tolerance test ( OGTT ) . Afterwards , using a r and omized trial design ( I RCT 201102275917N1 ) patients were allocated to either the metformin ( 1000 mg daily ) or pioglitazone ( 30 mg daily ) arm , and were reexamined after three months . Serum insulin , plasma glucose , and orexin concentrations were measured at baseline , during OGTT , and after three months . RESULTS Orexin concentrations significantly decreased after OGTT ( 0 vs. 120 min : 0.63 ± 0.07 vs. 0.31 ± 0.03 ng/ml , p < 0.001 ) . Insulin resistance determined by homeostasis model assessment of insulin resistance ( HOMA-IR ) was significantly and negatively correlated with orexin ( r = -0.301 , p = 0.024 ) . Furthermore , orexin concentrations were significantly and positively correlated with the insulin sensitivity index derived from OGTT ( r = 0.326 , p = 0.014 ) . Three-month treatment with metformin and pioglitazone significantly improved insulin sensitivity and increased orexin concentrations by 26 % ( p = 0.025 ) and 14 % ( p = 0.076 ) , respectively . Between-group analysis showed that changes in orexin concentrations with metformin and pioglitazone were not significantly different ( p = 0.742 ) . CONCLUSIONS There was a negative association between peripheral orexin concentrations and insulin resistance in type 2 diabetes patients . Three-month anti-hyperglycemic treatment with proportionate doses of metformin or pioglitazone increased orexin concentrations via amelioration of insulin resistance and improvement of glycemic control BACKGROUND Sleep-disordered breathing ( SDB ) is linked to adverse pregnancy outcomes . However , little is known about the association of SDB with timing of delivery . We examined the association of snoring frequency , a key SDB marker , and snoring intensity , a correlate of SDB severity , with time-to-delivery among a cohort of pregnant women . METHODS In this prospect i ve cohort study , 1483 third trimester pregnant women were recruited from the University of Michigan prenatal clinics . Women completed a question naire about their sleep , and demographic and pregnancy information was abstract ed from medical charts . After exclusion of those with hypertension or diabetes , 954 women were classified into two groups by their snoring onset timing , chronic or pregnancy-onset . Within each of these groups , women were divided into four groups based on their snoring frequency and intensity : non-snorers ; infrequent-quiet ; frequent-quiet ; or frequent-loud snorers . Cox proportional hazard regression models were used to investigate the association between snoring frequency and intensity and time-to-delivery , adjusting for maternal characteristics . RESULTS Chronic snoring was reported by half of the pregnant women , and of those , 7 % were frequent-loud snorers . Deliveries before 38 weeks ' gestation are completed occurred among 25 % of women with chronic , frequent-loud snoring . Compared with pre-pregnancy non-snorers , women with chronic frequent-loud snoring had an increased hazard ratio for delivery ( adjusted hazard ratio 1.60 , 95 % confidence interval 1.04 , 2.45 ) . CONCLUSIONS Snoring frequency and intensity is associated with time-to-delivery in women absent of hypertension or diabetes . Frequent-loud snoring may have a clinical utility to identify otherwise low-risk women who are likely to deliver earlier Output:

Associations between HCRT1 , metabolic and reproductive function are inconsistent .

MS2_1shot454

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND Antipsychotic drugs are usually the first line of treatment for schizophrenia ; however , many patients refuse or discontinue their pharmacological treatment . We aim ed to establish whether cognitive therapy was effective in reducing psychiatric symptoms in people with schizophrenia spectrum disorders who had chosen not to take antipsychotic drugs . METHODS We did a single-blind r and omised controlled trial at two UK centres between Feb 15 , 2010 , and May 30 , 2013 . Participants aged 16 - 65 years with schizophrenia spectrum disorders , who had chosen not to take antipsychotic drugs for psychosis , were r and omly assigned ( 1:1 ) , by a computerised system with permuted block sizes of four or six , to receive cognitive therapy plus treatment as usual , or treatment as usual alone . R and omisation was stratified by study site . Outcome assessors were masked to group allocation . Our primary outcome was total score on the positive and negative syndrome scale ( PANSS ) , which we assessed at baseline , and at months 3 , 6 , 9 , 12 , 15 , and 18 . Analysis was by intention to treat , with an ANCOVA model adjusted for site , age , sex , and baseline symptoms . This study is registered as an International St and ard R and omised Controlled Trial , number 29607432 . FINDINGS 74 individuals were r and omly assigned to receive either cognitive therapy plus treatment as usual ( n=37 ) , or treatment as usual alone ( n=37 ) . Mean PANSS total scores were consistently lower in the cognitive therapy group than in the treatment as usual group , with an estimated between-group effect size of -6.52 ( 95 % CI -10.79 to -2.25 ; p=0.003 ) . We recorded eight serious adverse events : two in patients in the cognitive therapy group ( one attempted overdose and one patient presenting risk to others , both after therapy ) , and six in those in the treatment as usual group ( two deaths , both of which were deemed unrelated to trial participation or mental health ; three compulsory admissions to hospital for treatment under the mental health act ; and one attempted overdose ) . INTERPRETATION Cognitive therapy significantly reduced psychiatric symptoms and seems to be a safe and acceptable alternative for people with schizophrenia spectrum disorders who have chosen not to take antipsychotic drugs . Evidence -based treatments should be available to these individuals . A larger , definitive trial is needed . FUNDING National Institute for Health Research BACKGROUND The effectiveness of a psychosocial skills training ( PSST ) approach applied to chronic out- patients with schizophrenia was examined . We hypothesized that the PSST programme , which included treatment as usual ( TAU ) , PSST and family therapy ( FT ) , would reduce positive and negative symptoms , prevent relapse and rehospitalization , and improve psychosocial functioning ( PSF ) , global functioning and treatment adherence . METHOD Eighty-two patients were r and omly assigned to receive either TAU [ antipsychotic medication ( AP ) ; n=39 ] or the PSST approach ( TAU+PSST+FT ; n=43 ) . The two groups were assessed at intake and after completion of 1 year of treatment . RESULTS There were statistically significant differences between the two groups . Patients in the PSST group improved their symptomatology , psychosocial and global functioning ( symptoms and psychological , social and occupational functioning ) , showed lower relapse , rehospitalization and drop-out rates , a higher level of compliance with AP medication , and a high level of therapeutic adherence in comparison with TAU patients , whose symptoms also improved although they showed no improvement in any of the clinical or psychosocial variables . A comparison of the st and ardized effect sizes showed a medium and a large effect size of PSF and global functioning for the PSST group and a non-effect size for the TAU group . CONCLUSIONS A higher level of effectiveness was demonstrated when combining TAU , PSST and FT in comparison with AP medication alone . The PSST approach should be recommended for clinical practice OBJECTIVE The present study aims to assess the efficacy of a structured psychoeducational group intervention for adolescents with early-onset psychosis and their families . The intervention was implemented in parallel in 2 separate groups by focusing specifically on problem-solving strategies and structured psychosis-related information to manage daily life difficulties associated with the disease , to mitigate crises , and to prevent relapses . METHOD We performed a 9-month , r and omized , rater-blinded clinical trial involving 55 adolescent patients with early-onset psychosis and either or both of their parents . A psychoeducational problem-solving group intervention ( n = 27 ) was compared with a nonstructured group intervention ( n = 28 ) . The primary outcomes were number of hospitalizations , days of hospitalization , and visits to the emergency department . The secondary outcome measures were clinical variables and family environment . RESULTS Assessment s were performed before and after the intervention . At the end of the group intervention , 15 % of patients in the psychoeducational group and 39 % patients in the nonstructured group had visited the emergency department ( χ² = 3.62 , df = 1 , p = .039 ) . The improvement in negative symptoms was more pronounced in the psychoeducational group ( 12.84 [ 7.87 ] ) than in the nonstructured group ( 15.81 [ 6.37 ] ) ( p = .039 ) . CONCLUSION A parallel psychoeducational group intervention providing written instructions in a structured manner could help adolescents with early-onset psychosis and their parents to manage crises by implementing problem-solving strategies within the family , thus reducing the number of visits to the emergency department . Negative symptoms improved in adolescents in the psychoeducational group . Clinical trial registration information -- Intervention Module AGES ( AGES-CM ) ; http:// clinical trials.gov/ ; NCT02101372 . [ corrected ] Objectives : To investigate the effectiveness of a long established intervention , occupational therapy for people with psychotic conditions , and to inform future research design s. Design : A pilot r and omized controlled trial . Setting : Two community mental health teams in a UK city . Participants : Forty-four adults with schizophrenia or other psychotic conditions , and functional problems . Interventions : Twelve months of individualized occupational therapy in community setting s , as an adjunct to usual care and compared to treatment as usual . A two to one r and omization ratio was used in favour of occupational therapy . Outcome measures : Social Functioning Scale , Scale for the Assessment of Negative Symptoms and employment . Results : Both groups ' scores on Social Functioning Scale and Scale for the Assessment of Negative Symptoms showed significant improvement over 12 months . The Social Functioning Scale overall mean difference for occupational therapy was 2.33 , P=0.020 and for treatment as usual was 6.17 , P=0.023 . The Scale for the Assessment of Negative Symptoms total mean difference for occupational therapy was -16.25 , P<0.001 and for treatment as usual was -17.36 , P= 0.011 . There were no differences between the two groups on any of the outcome measures . After 12 months the occupational therapy group showed clinical ly significant improvements that were not apparent in the control group . These were in four subscales of the Social Functioning Scale : relationships , independence performance , independence competence and recreation . Out of 30 people receiving occupational therapy those with a clinical level of negative symptoms reduced from 18 ( 64 % ) to 13 ( 46 % ) , P=0.055 . Conclusion : This pilot study suggested that individualized occupational therapy may contribute to recovery but more focus is recommended on people 's cognitive abilities and employment This r and omised clinical trial assessed the effects of a 16‐week cognitive remediation programme ( NEUROCOM ) combined with an early intervention service ( EIS ) vs. EIS alone BACKGROUND There is increasing evidence that cognitive-behavioural therapy can be an effective intervention for patients experiencing drug-refractory positive symptoms of schizophrenia . AIMS To investigate the effects of cognitive-behavioural therapy on in- patients with treatment-refractory psychotic symptoms . METHOD Manualised therapy was compared with supportive counselling in a r and omised controlled study . Both interventions were delivered by experienced psychologists over 16 sessions of treatment . Therapy fidelity was assessed by two independent raters . Participants underwent masked assessment at baseline , after treatment and at 6 months ' follow-up . Main outcome measures were the Positive and Negative Syndrome Scale and the Psychotic Symptoms Rating Scale . The analysis was by intention to treat . RESULTS Participants receiving cognitive cognitive-behavioural therapy had improved with regard to auditory hallucinations and illness insight at the post-treatment assessment , but these findings were not maintained at follow-up . CONCLUSIONS Cognitive-behavioural therapy showed modest short-term benefits over supportive counselling for treatment-refractory positive symptoms of schizophrenia OBJECTIVE Cognitive remediation ( CR ) approaches have demonstrated to be effective in improving cognitive functions in schizophrenia . However , there is a lack of integrated CR approaches that target multiple neuro- and social-cognitive domains with a special focus on the generalization of therapy effects to functional outcome . METHOD This 8-site r and omized controlled trial evaluated the efficacy of a novel CR group therapy approach called integrated neurocognitive therapy ( INT ) . INT includes well-defined exercises to improve all neuro- and social-cognitive domains as defined by the Measurement And Treatment Research to Improve Cognition in Schizophrenia ( MATRICS ) initiative by compensation and restitution . One hundred and fifty-six out patients with a diagnosis of schizophrenia or schizoaffective disorder according to DSM-IV-TR or ICD-10 were r and omly assigned to receive 15 weeks of INT or treatment as usual ( TAU ) . INT patients received 30 bi-weekly therapy sessions . Each session lasted 90min . Mixed models were applied to assess changes in neurocognition , social cognition , symptoms , and functional outcome at post-treatment and at 9-month follow-up . RESULTS In comparison to TAU , INT patients showed significant improvements in several neuro- and social-cognitive domains , negative symptoms , and functional outcome after therapy and at 9-month follow-up . Number-needed-to-treat analyses indicate that only 5 INT patients are necessary to produce durable and meaningful improvements in functional outcome . CONCLUSIONS Integrated interventions on neurocognition and social cognition have the potential to improve not only cognitive performance but also functional outcome . These findings are important as treatment guidelines for schizophrenia have criticized CR for its poor generalization effects BACKGROUND There is good evidence now that cognitive behaviour therapy ( CBT ) is effective in the treatment of people suffering from schizophrenia . There is also some evidence that the benefits of CBT persist after the end of treatment and that the direct costs of providing CBT as an adjunct to st and ard care are no higher than the direct costs of st and ard care alone . The aims of the present study were to discover if the benefits of CBT for acute schizophrenia which were found 1 year after index admission persist for another year , and to evaluate the comparative costs of providing CBT . METHOD Consecutive admissions meeting criteria were recruited . After screening , 43 were assigned at r and om to a treatment-as-usual ( TAU ) control group and 47 were assigned to TAU plus CBT . Patients ( 73 % of original ) were rated on symptoms and social functioning 2 years after index admission . An evaluation of the direct costs of services was also completed . RESULTS The CBT group had maintained its advantage over the TAU group on negative symptoms and social functioning but had lost the advantage it previously enjoyed in positive symptoms . The difference between groups in total direct costs over the 2 years was not statistically significant despite the cost of providing CBT . CONCLUSIONS Some of the benefits of CBT for patients suffering acute psychotic episodes persist for 2 years . After the end of regular treatment , CBT should probably be targeted on the appearance of early signs of relapse to forestall the re-emergence of positive symptoms Background : Lifestyle moderate-intensity physical activity can lower the risk of over twenty chronic health conditions , whilst inactivity reduces daily functioning and physical health of individuals living with schizophrenia . This study conducted in 2014 examines the effect of structured walking participation on QOL , psychosocial functioning and symptoms in Hospital Permai , one of the largest psychiatry institution in Asia Method : Chronic patients with schizophrenia ( n=104 ) who met inclusion criteria were r and omised to either a 3-month structured walking intervention or a treatment-as-usual arm . The Positive and Negative Syndrome Scale ( PANSS ) , global functioning ( PSP ) and QOL ( SF-36 ) were measured at baseline and after the 3-month interval . Results : At 3 month follow-up , there were significant within group differences in QOL ( SF-36 ) , psychiatric symptoms ( PANSS ) , and personal and social performance ( PSP ) . There were statistically significant increase in the median SF-36 scores , with increases shown in physical functioning ( p<.001 ) , physical role limitations ( p<.05 ) , social functioning ( p<.01 ) in the intervention group compared to treatment-as-usual group . Statistically significant reduction of median PANSS score of the intervention group were noted in positive ( p<0.001 ) and negative ( p<0.01 ) symptom , and general psychopathology ( p<0.01 ) scales . Statistically significant increase in the median PSP score ( p<0. Output:

Conclusions Specific psychological and psychosocial interventions have utility in ameliorating negative symptoms in psychosis and should be included in the treatment of negative symptoms .

MS2_1shot455

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: PURPOSE To determine the effects of breast cancer-specific print material s and step pedometers on physical activity ( PA ) and quality of life ( QoL ) in breast cancer survivors . PATIENTS AND METHODS Breast cancer survivors ( N = 377 ) were r and omly assigned to receive one of the following : a st and ard public health recommendation for PA , previously developed breast cancer-specific PA print material s , a step pedometer , or a combination of breast cancer-specific print material s and step pedometers . The primary outcome was self-reported moderate/vigorous PA minutes per week . Secondary outcomes were QoL ( Functional Assessment of Cancer Therapy-Breast ) , fatigue , self-reported brisk walking , and objective step counts . Assessment s were conducted at baseline and postintervention ( 12 weeks ) . RESULTS Attrition was 10.3 % ( 39 of 377 ) . On the basis of linear mixed-model analyses , PA increased by 30 minutes/week in the st and ard recommendation group compared with 70 minutes/week in the print material group ( mean difference , 39 minutes/week ; 95 % CI = -10 to 89 ; d = 0.25 ; P = .117 ) , 89 minutes/week in the pedometer group ( mean difference , 59 minutes/week ; 95 % CI , 11 to 108 ; d = 0.38 ; P = .017 ) , and 87 minutes/week in the combined group ( mean difference , 57 minutes/week ; 95 % CI , 8 to 106 ; d = 0.37 ; P = .022 ) . For brisk walking minutes/week , all three intervention groups reported significantly greater increases than the st and ard recommendation group . The combined group also reported significantly improved QoL ( mean difference , 5.8 ; 95 % CI , 2.0 to 9.6 ; d = 0.33 ; P = .003 ) and reduced fatigue ( mean difference , 2.3 ; 95 % CI , 0.0 to 4.7 ; d = 0.25 ; P = .052 ) compared with the st and ard recommendation group . CONCLUSION Breast cancer-specific PA print material s and pedometers may be effective strategies for increasing PA and QoL in breast cancer survivors . A combined approach appears to be optimal . CLINICAL TRIAL REGISTRATION Clinical Trials.gov Identifier The Sickness Impact Profile ( SIP ) and the Hospital Anxiety and Depression scale ( HAD ) were used for assessment of physical and psychosocial functioning and emotional distress in patients with small cell lung cancer ( SCLC ) receiving chemotherapy . Treatment schedules extended over 12 months . Before treatment sixty-two patients , 36 - 80 years of age , completed the question naires and a selection of lung cancer symptom items . Approximately 50 % of the patients reported clinical ly significant physical dysfunction , while emotional distress was reported by 25 % and social restraints by 40 % . Self-reported overall dysfunction , as assessed by SIP total index , was clinical ly significant in 60 % of the patients . SIP physical and total indices were strongly related to WHO performance status ( grade 0 - 4 ) . The assessment was subsequently repeated every third month during the treatment period . Overall tumour response rate was 82 % . The changes of physical and psychosocial functioning , as assessed by SIP , were significantly related to tumour response , although a persistent substantial overall dysfunction was shown among 50 % of the responders after 3 months and among c. 40 % after 6 months . In addition to tumour response , pain and appetite changes correlated with the change of overall SIP in multivariate analysis , implying the importance of pain control and appetite stimulating measures for patients with advanced cancer . Anxiety and depression , as measured by HAD , were reduced in 21 patients who completed 12 months chemotherapy , but only anxiety co-varied with tumour response . The results lend support to the use of the generic SIP and HAD as outcome measures in clinical research with SCLC patients receiving chemotherapy Breast cancer ( BC ) patients experience multiple symptoms as a result of diagnosis and treatment . While surveillance for detecting cancer recurrence is fundamental to follow-up care , managing symptoms , and promoting health behaviors are equally important . UCSF has implemented a secure online health question naire enabling BC patients to provide up date s of their health history and symptoms . We r and omly selected a sample of stage I – III BC patients ( n = 106 ) who completed a question naire before a medical oncology visit between August 2010 and January 2011 and consented to have data used for research . We conducted a chart review calculating the number of symptoms reported in the question naire , the clinic note only , and both question naire and clinic note , excluding chronic symptoms addressed previously . Self-reported data on exercise and alcohol consumption was compared to documentation of these lifestyle factors in clinic notes . Patients reported significantly more symptoms using the online question naire ( mean = 3.8 , range 0–13 ) than were documented by the provider in clinic notes ( mean = 1.8 , range 0–7 ; p < 0.001 for the difference ) . A regression plot comparing the percentage of symptoms agreed upon by the patient and provider and the percentage of symptoms addressed yields a slope of 0.56 ( 95 % CI 0.41–0.71 ) . The number of self-reported symptoms correlates with self-reported Karnofsky scale such that the number of symptoms reported by the patient increases linearly with this score until a threshold and it then plateaus ( p < 0.001 ) . Exercise behavior and alcohol consumption were reported in 100 % of the online question naires , but was documented in only 30/106 ( 28 % ) and 75/106 ( 70 % ) of charts review ed . In 19/75 ( 25 % ) charts with alcohol consumption documented , there was substantial discordance between patient and clinician reporting . Electronic data collection of BC patient-reported outcomes has a positive effect on symptom management and identification of opportunities for risk-reducing behavior change OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity OBJECTIVE The interpretation of health-related quality of life ( HRQL ) data from clinical trials can be enhanced by underst and ing the degree of change in HRQL scores that is considered meaningful . Our objectives were to combine distribution-based and two anchor-based approaches to identify minimally important differences ( MIDs ) for the 27-item Trial Outcome Index ( TOI ) , the seven-item Social Well-Being ( SWB ) subscale , and the six-item Emotional Well-being ( EWB ) subscale from the Functional Assessment of Cancer Therapy-Biological Response Modifiers ( FACT-BRM ) instrument . METHODS Distribution-based MIDs were based on the st and ard error of measurement . Anchor-based approaches utilized patient-reported global rating of change ( GRC ) and change in physician-reported performance status rating ( PSR ) . Correlations and weighted kappa statistics were used to assess association and agreement between the two anchors . FACT-BRM changes were evaluated for three time periods : baseline to month 1 , month 2 to month 3 , and month 5 to month 6 . RESULTS Association between GRC and change in PSR was poor . Correlation between the anchors and HRQL change scores was largest at month 1 and decreased through month 6 . Combining results from all approaches , the MIDs identified were 5 - 8 points for the TOI , 2 points for the SWB subscale , and 2 - 3 points for the EWB subscale . CONCLUSIONS We combined patient-reported estimates , physician-reported estimates , and distribution-based estimates to derive MIDs for HRQL outcomes from the FACT-BRM . These results will enable interpretation of treatment group effects in a clinical trial setting , and they can be used to estimate sample size or power when design ing future studies BACKGROUND Patient-reported outcomes ( PROs ) are essential for evaluating treatment effects on health-related quality of life and symptoms from the patient 's perspective . This study sought to evaluate the psychometric properties of the nine-item Functional Assessment of Cancer Therapy/National Comprehensive Cancer Network Colorectal Cancer Symptom Index ( FCSI-9 ) in a metastatic colorectal cancer ( mCRC ) population . METHODS The FCSI-9 and EQ-5D were administered every 2 - 4 weeks to mCRC subjects in a phase III clinical trial . Three hundred ninety-one mCRC subjects completed the question naires at baseline and at least one follow-up assessment . Internal consistency reliability , test-retest reliability , construct validity , known groups validity , responsiveness , and the minimum important difference ( MID ) of the FCSI-9 were evaluated . RESULTS The internal consistency and test-retest reliability of the FCSI-9 were acceptable ( 0.81 and 0.76 , respectively ) . Construct validity was supported based on moderate correlations with the EQ-5D . Known groups validity was evaluated by examining the FCSI-9 scores of subjects categorized by their Eastern Cooperative Oncology Group performance status ( PS ) score . Subjects with better PS scores reported significantly higher FCSI-9 scores than those with lower PS scores at both baseline and week 8 . Responsiveness , as measured by Guyatt 's statistic , was 0.77 from baseline to week 8 and 0.60 from week 4 to week 12 . Considering all data together , the MID of the FCSI-9 is estimated to be in the range of 1.5 - 3.0 points . CONCLUSION Results provide preliminary evidence of the reliability , validity , and responsiveness of the FCSI-9 The st and ard approach for documenting symptomatic adverse events ( AEs ) in cancer clinical trials involves investigator reporting using the National Cancer Institute 's ( NCI 's ) Common Terminology Criteria for Adverse Events ( CTCAE ) . Because this approach underdetects symptomatic AEs , the NCI issued two contracts to create a patient-reported outcome ( PRO ) measurement system as a companion to the CTCAE , called the PRO-CTCAE . This Commentary describes development of the PRO-CTCAE by a group of multidisciplinary investigators and patient representatives and provides an overview of qualitative and quantitative studies of its measurement properties . A systematic evaluation of all 790 AEs listed in the CTCAE identified 78 appropriate for patient self-reporting . For each of these , a PRO-CTCAE plain language term in English and one to three items characterizing the frequency , severity , and /or activity interference of the AE were created , rendering a library of 124 PRO-CTCAE items . These items were refined in a cognitive interviewing study among patients on active cancer treatment with diverse educational , racial , and geographic background s. Favorable measurement properties of the items , including construct validity , reliability , responsiveness , and between-mode equivalence , were determined prospect ively in a demographically diverse population of patients receiving treatments for many different tumor types . A software platform was built to administer PRO-CTCAE items to clinical trial participants via the internet or telephone interactive voice response and was refined through usability testing . Work is ongoing to translate the PRO-CTCAE into multiple language s and to determine the optimal approach for integrating the PRO-CTCAE into clinical trial workflow and AE analyses . It is envisioned that the PRO-CTCAE will enhance the precision and patient-centeredness of adverse event reporting in cancer clinical research Data from a clinical study of 86 pancreatic cancer patients with involuntary , significant weight loss ( cachexia ) were used to explore the relationship between patient-reported outcomes ( PROs ) and survival . In all , 28 pancreatic cancer patients with cachexia were given gemcitabine ( Gemzar ) plus 3 mg/kg of infliximab ( Remicade ) , 28 were given gemcitabine Output:

Irrespective of the method of capturing PROs or FPS , the quantified level of association between these two areas was moderate at best , providing evidence that FPS and PRO assessment s offer unique information to assist clinicians in their decision-making

MS2_1shot456

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: We evaluated the efficacy of LifeWindows , a theory-based , computer-administered antiretroviral ( ARV ) therapy adherence support intervention , delivered to HIV + patients at routine clinical care visits . 594 HIV + adults receiving HIV care at five clinics were r and omized to intervention or control arms . Intervention vs. control impact in the intent-to-treat sample ( including participants whose ARVs had been entirely discontinued , who infrequently attended care , or infrequently used LifeWindows ) did not reach significance . Intervention impact in the On Protocol sample ( 328 intervention and control arm participants whose ARVs were not discontinued , who attended care and were exposed to LifeWindows regularly ) was significant . On Protocol intervention vs. control participants achieved significantly higher levels of perfect 3-day ACTG-assessed adherence over time , with sensitivity analyses maintaining this effect down to 70 % adherence . This study supports the utility of LifeWindows and illustrates that patients on ARVs who persist in care at clinical care sites can benefit from adherence promotion software . ResumenEvaluamos la eficacia de LifeWindows , una intervención de apoyo para la adherencia a la terapia antirretroviral ( TAR ) basada en teoría y con administración informatizada para pacientes con VIH + en sus visitas clínicas rutinarias . 594 adultos de cinco clínicas con VIH + y bajo tratamiento fueron aleatoriamente asignados a un grupo de intervención o de control . No se alcanzó significación estadística al comparar ambos grupos bajo la estrategia de ‘ intención de tratar ’ ( incluyendo los participantes cuyos TAR se habían interrumpido por completo , habían asistido a la clínica en pocas ocasiones , o usaron LifeWindows con poca frecuencia ) . Sin embargo , la intervención obtuvo un impacto significativo cu and o se evaluó con la muestra bajo Protocol o ( un total de 328 participantes cuyos TAR no fueron interrumpidos , asistieron a sus visitas clínicas y se expusieron a LifeWindows regularmente ) . Los participantes bajo Protocol o de intervención obtuvieron niveles más altos de adherencia que el grupo control en tres días de Estudios de Grupos Clinicos con SIDA ( EGCS ) con repetidas evaluaciones y manteniendo como mínimo un 70 % de la adherencia . Este estudio apoya la utilidad de LifeWindows e indica que los pacientes con TAR que asisten a las visitas clínicas , pueden beneficiarse de este software de promoción de la adherencia Background : There is a lack of effective behavioral interventions for HIV-positive injection drug users ( IDUs ) . We sought to evaluate the efficacy of an intervention to reduce sexual and injection transmission risk behaviors and to increase utilization of medical care and adherence to HIV medications among this population . Methods : HIV-positive IDUs ( n = 966 ) recruited in 4 US cities were r and omly assigned to a 10-session peer mentoring intervention or to an 8-session video discussion intervention ( control condition ) . Participants completed audio computer-assisted self-interviews and had their blood drawn to measure CD4 cell count and viral load at baseline and at 3-month ( no blood ) , 6-month , and 12-month follow-ups . Results : Overall retention rates for r and omized participants were 87 % , 83 % , and 85 % at 3 , 6 , and 12 months , respectively . Participants in both conditions reported significant reductions from baseline in injection and sexual transmission risk behaviors , but there were no significant differences between conditions . Participants in both conditions reported no change in medical care and adherence , and there were no significant differences between conditions . Conclusions : Both interventions led to decreases in risk behaviors but no changes in medical outcomes . The characteristics of the trial that may have contributed to these results are examined , and directions for future research are identified Purpose The purpose of this study was to examine whether integrating depression treatment into care for type 2 diabetes mellitus among older African Americans improved medication adherence , glycemic control , and depression outcomes . Methods Older African Americans prescribed pharmacotherapy for type 2 diabetes mellitus and depression from physicians at a large primary care practice in west Philadelphia were r and omly assigned to an integrated care intervention or usual care . Adherence was assessed at baseline , 2 , 4 , and 6 weeks using the Medication Event Monitoring System to assess adherence . Outcomes assessed at baseline and 12 weeks included st and ard laboratory tests to measure glycemic control and the Center for Epidemiologic Studies Depression Scale ( CES-D ) to assess depression . Results In all , 58 participants aged 50 to 80 years participated . The proportion of participants who had 80 % or greater adherence to an oral hypoglycemic ( intervention 62.1 % vs usual care 24.1 % ) and an antidepressant ( intervention 62.1 % vs usual care 10.3 % ) was greater in the intervention group in comparison with the usual care group at 6 weeks . Participants in the integrated care intervention had lower levels of glycosylated hemoglobin ( intervention 6.7 % vs usual care 7.9 % ) and fewer depressive symptoms ( CES-D mean scores : intervention 9.6 vs usual care 16.6 ) compared with participants in the usual care group at 12 weeks . Conclusion A pilot r and omized controlled trial integrating type 2 diabetes mellitus treatment and depression was successful in improving outcomes among older African Americans . Integrated interventions may be more feasible and effective in real-world practice s with competing dem and s for limited re sources Background Hypertension is more prevalent and clinical ly severe among African – Americans than whites . Several health behaviors influence blood pressure ( BP ) control , but effective , accessible , culturally sensitive interventions that target multiple behaviors are lacking . Purpose We evaluated a culturally adapted , automated telephone system to help hypertensive , urban African – American adults improve their adherence to their antihypertensive medication regimen and to evidence -based guidelines for dietary behavior and physical activity . Methods We r and omized 337 hypertensive primary care patients to an 8-month automated , multi-behavior intervention or to an education-only control . Medication adherence , diet , physical activity , and BP were assessed at baseline and every 4 months for 1 year . Data were analyzed using longitudinal modeling . Results The intervention was associated with improvements in a measure of overall diet quality ( + 3.5 points , p < 0.03 ) and in energy expenditure ( + 80 kcal/day , p < 0.03 ) . A decrease in systolic BP between groups was not statistically significant ( −2.3 mmHg , p = 0.25 ) . Conclusions Given their convenience , scalability , and ability to deliver tailored messages , automated telecommunications systems can promote self-management of diet and energy balance in urban African – Americans Optimists ( people who have positive expectations about the future ) have been shown to perform more health-promoting behaviors than pessimists . This study attempts to alter individuals ’ levels of optimism , and thereby their health behaviors , by having them write about a positive future . HIV-infected women ( N = 40 ) on combination therapies were r and omly assigned to write about a positive future or assigned to a no-writing control group . Among participants who were low in optimism , the writing intervention led to increased optimism , a trend toward increased self-reported adherence to medications , and decreased distress from medication side effects , compared to controls who did not write . Participants who were high in optimism showed the opposite effects after writing about the future . Results suggest that a future-oriented writing intervention may be a promising technique to increase medication adherence and decrease symptom , distress in pessimistic individuals A r and omized 2-group medication adherence intervention is evaluated with HIV-infected adults ( N = 141 ) assessed at baseline , 3- , and 9-month follow-ups . Cognitive ( self-efficacy , behavioral intent ) , mental health ( depression , well-being ) , and substance use indicators were the outcome measures . In addition , a posttest-only analysis from 3 to 9 months evaluates intervention impact on antiretroviral adherence , measured through Medication Event Monitoring System and pill counts . Compared to the st and ard care group , the intervention group showed significant increases in adherence self-efficacy and behavioral intent at 3 and 9 months and marginal improvements in mental health . Although the st and ard care group had higher adherence at 3 months ( no baseline data were available prior to intervention ) , intervention group patients showed significant increases in adherence from 3 to 9 months . Although adherence levels achieved by intervention patients may not be sufficient for virological control , this is one of the first studies to provide promising results of longer term effectiveness of a behavioral adherence intervention Background Up to 50 % of patients do not take medications as prescribed . Interventions to improve adherence are needed , with an underst and ing of which patients benefit most . Objective To test the effect of two low-literacy interventions on medication adherence . Design R and omized controlled trial , 2 × 2 factorial design . Participants Adults with coronary heart disease in an inner-city primary care clinic . Interventions For 1 year , patients received usual care , refill reminder postcards , illustrated daily medication schedules , or both interventions .Main Measures The primary outcome was cardiovascular medication refill adherence , assessed by the cumulative medication gap ( CMG ) . Patients with CMG < 0.20 were considered adherent . We assessed the effect of the interventions overall and , post-hoc , in subgroups of interest . Key Results Most of the 435 participants were elderly ( mean age = 63.7 years ) , African-American ( 91 % ) , and read below the 9th- grade level ( 78 % ) . Among the 420 subjects ( 97 % ) for whom CMG could be calculated , 138 ( 32.9 % ) had CMG < 0.20 during follow-up and were considered adherent . Overall , adherence did not differ significantly across treatments : 31.2 % in usual care , 28.3 % with mailed refill reminders , 34.2 % with illustrated medication schedules , and 36.9 % with both interventions . In post-hoc analyses , illustrated medication schedules led to significantly greater odds of adherence among patients who at baseline had more than eight medications ( OR = 2.2 ; 95 % CI , 1.21 to 4.04 ) or low self-efficacy for managing medications ( OR = 2.15 ; 95 % CI , 1.11 to 4.16 ) ; a trend was present among patients who reported non-adherence at baseline ( OR = 1.89 ; 95 % CI , 0.99 to 3.60 ) . Conclusions The interventions did not improve adherence overall . Illustrated medication schedules may improve adherence among patients with low self-efficacy , polypharmacy , or baseline non-adherence , though this requires confirmation Treatment advocacy ( TA ) programs , based in AIDS service organizations and clinics , aim to engage clients into care and support antiretroviral treatment ( ART ) adherence through client-centered counseling ; advocate for patients with providers ; and provide social service referrals . Systematic evaluations of TA are lacking . We conducted a non-r and omized evaluation examining relationships of TA participation to adherence , care engagement , social services utilization , unmet needs , patient self-advocacy , and adherence self-efficacy among 121 HIV-positive clients ( 36 in TA , 85 not in TA ; 87 % male , 34 % African American , 31 % White , 19 % Latino ) . In multivariate models , TA participants ( vs. non-TA participants ) showed higher electronically monitored [ 85.3 % vs. 70.7 % of doses taken ; b(SE ) = 13.16(5.55 ) , p < .05 ] and self-reported [ 91.1 % vs. 75.0 % ; b(SE ) = 11.60(5.65 ) , p < .05 ] adherence ; utilized more social service programs [ Ms = 5.2 vs. 3.4 ; b(SE ) = 1.97(0.48 ) , p < .0001 ] ; and had fewer unmet social-service needs [ Ms = 1.8 vs. 2.7 ; b(SE ) = -1.06(0.48 ) , p < .05 ] . Findings suggest the need for a r and omized controlled trial of TA BACKGROUND To improve medication adherence in cardiac patients , in partnership with a safety-net provider , this research team developed and evaluated a low-literacy medication education tool . METHODS Using principles of community-based participatory research , the team developed a prototype of a low-literacy hospital discharge medication education tool , customizable for each patient , featuring instruction-specific icons and pictures of pills . In 2007 , a r and omized controlled clinical trial was performed , testing the tool 's effect on posthospitalization self-reported medication adherence and knowledge , 2 weeks postdischarge in English- and Spanish-speaking safety-net in patients . To vali date the self-report measure , 4 weeks postdischarge , investigators collected self-reports of the number of pills remaining for each medication in a sub sample of participants . Nurses rated tool acceptability . RESULTS Among the 166/210 eligible participants ( 79 % ) completing the Week-2 interview , self-reported medication adherence was 70 % ( 9 Output:

Primary studies infrequently reported strategies to enhance cultural relevance . Exploratory moderator analyses found no evidence that associated cultural relevance strategies with better medication adherence outcomes .

MS2_1shot457

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND While physical therapy is an effective element in the rehabilitation of rotator cuff ( RC ) disease , the most effective sequence of exercise training interventions has not been defined . HYPOTHESIS/ PURPOSE The purpose of this study is to determine if there is a difference in pain or function in patients who are given RC strengthening prior to or after initiating scapular stabilization exercises . STUDY DESIGN Level I r and omized crossover trial . METHODS This was a prospect i ve study of 26 men and 14 women with a mean age 51 who were diagnosed with subacromial impingement syndrome ( SAIS ) . They were r and omly assigned to one of two groups for a comprehensive and st and ardized rehabilitation program over six visits at an orthopedic outpatient clinic . One group was prescribed a 4-week program of scapular stabilization exercises while the other group began with RC strengthening exercises . The crossover design had each group add the previously excluded four exercises to their second month of rehabilitation . RESULTS The results showed significant improvements in pain ( p < 0.001 ) , function ( p < 0.001 ) , and patient satisfaction ( p < 0.001 ) at all follow-up times for both groups . There was not a statistically significant difference in pain or function at any follow-up period for initiating one group of exercise before the other ( p > 0.05 ) . There was a statistically significant interaction between the patient 's global rating of change at the 4 week follow-up as compared to 8 weeks ( p = 0.04 ) or 16 ( p < 0.001 ) . CONCLUSION Patients with SAIS demonstrate improvement in pain and function with a st and ardized program of physical therapy regardless of group exercise sequencing . LEVEL OF EVIDENCE 1b Background and purpose A programme based on eccentric exercises for treating subacromial pain was in a previous study found effective at 3-month follow-up . The purpose s of the present study were to investigate whether the results were maintained after 1 year and whether the baseline Constant-Murley score , rotator cuff status and radiological findings influenced the outcome . Patients and methods 97 patients on the waiting list for arthroscopic subacromial decompression had been r and omised to a specific exercise programme or unspecific exercises ( controls ) . After 3 months of exercises , the patients were asked whether they still wanted surgery and this option was available until a 1-year follow-up . 1 year after inclusion or 1 year after surgery , the number of patients who decided to have surgery in each group was compared . The choice of surgery was related to the baseline Constant-Murley score , ultrasound and radiographs taken at inclusion . Results All patients had improved significantly ( p<0.0001 ) in the Constant-Murley score at the 1-year follow-up . Significantly more patients in the control group decided to have surgery ( 63 % ) than those in the specific exercise group ( 24 % ; p<0.0001 ) . Patients who decided to have surgery had a significantly lower baseline Constant-Murley score and more often a full-thickness tear . Patients with partial tears did not differ from those with intact tendons . Interpretation The positive short-term results of specific exercises were maintained after 1 year , and this exercise strategy reduces the need for surgery . Full-thickness tear and a low baseline Constant-Murley score appear to be a predictive marker for a less good outcome . Trial registration number Clinical trials NCT01037673 Evidence -based practice involves the use of evidence from systematic review s and r and omised controlled trials , but the extent of this evidence in physiotherapy has not previously been surveyed . The aim of this survey is to describe the quantity and quality of r and omised controlled trials and the quantity of systematic review s relevant to physiotherapy . The Physiotherapy Evidence Data base ( PEDro ) was search ed . The quality of trials was assessed with the PEDro scale . The search identified a total of 2,376 r and omised controlled trials and 332 systematic review s. The first trial was published in 1955 and the first review was published in 1982 . Since that time , the number of trials and review s has grown exponentially . The mean PEDro quality score has increased from 2.8 in trials published between 1955 and 1959 to 5.0 for trials published between 1995 and 1999 . There is a substantial body of evidence about the effects of physiotherapy . However , there remains scope for improvements in the quality of the conduct and reporting of clinical trials Aim : To test the hypothesis that work related mechanical and psychosocial factors predict new onset shoulder pain in newly employed workers . Methods : Two year prospect i ve study of newly employed workers from 12 diverse occupational setting s. At baseline , 1081 subjects provided information on work related mechanical and psychosocial risk factors , and current pain status . Results : In all , 803 ( 74 % ) subjects were free from shoulder pain at baseline . Of those , 638 ( 79 % ) responded at 12 months and 476 ( 88 % ) at 24 months . New onset shoulder pain was reported by 93 ( 15 % ) and 73 ( 15 % ) subjects respectively . An increased risk of symptom onset was found in subjects reporting mechanical exposures involving heavy weights including lifting with one or two h and s , carrying on one shoulder , lifting at or above shoulder level , and pushing or pulling . Working with h and s above shoulder level was also predictive of new onset shoulder pain . Of the psychosocial factors examined , the strongest predictor was monotonous work . Those individuals with any other previous pain also had an increased risk of new onset shoulder pain at follow up . In multivariate analysis , lifting heavy weights with one or two h and s , pushing or pulling heavy weights , working with h and s above shoulder level , and monotonous work were independently associated with new onset shoulder pain . Conclusions : This study supports the hypothesised relation between mechanical risk factors and shoulder pain . In general , work related psychosocial factors were modestly associated with new onset shoulder pain . However , monotonous work was a strong risk factor for new onset shoulder pain Background : Dysfunction in the kinetic chain caused by poor scapula stabilization can contribute to shoulder injuries and Shoulder Impingement Syndrome ( SIS ) . The purpose of this study was to compare the effectiveness of two treatment approaches scapular stabilization based exercise therapy and physical therapy in patients with SIS . Methods : The study is a r and omized clinical trial in which 68 patients with SIS were r and omly assigned in two groups of exercise therapy ( ET ) and physical therapy ( PT ) and received 18 sessions of treatment . Pain , shoulders ' range of abduction and external rotation , shoulder protraction , scapular rotation and symmetry as well as postural assessment and Pectoralis minor length were evaluated pre and post intervention . The paired- sample t test and the independent sample t test were applied respectively to determine the differences in each group and between two groups . Results : Our findings indicated significant differences in abduction and external rotation range , improvement of forward shoulder translation and increase in the flexibility of the involved shoulder between the two groups ( respectively ; p=0.024 , p=0.001 , p<0/0001 , p<0/0001 ) . No significant difference was detected in pain reduction between the groups ( p=0.576 ) . Protraction of the shoulder ( p<0.0001 ) , forward head posture ( p<0/0001 ) and mid thoracic curvature ( p<0.0001 ) revealed a significant improvement in the ET group . Apparent changes occurred in scapular rotation and symmetry in both groups but no significant differences were observed between the two groups ( respectively ; p=0.183 , p=0.578 ) . Conclusion : The scapular stabilization based exercise intervention was successful in increasing shoulder range , decreasing forward head and shoulder postures and Pectoralis minor flexibility The purpose of this clinical trial is to compare the effectiveness of a scapular-focused treatment with a control therapy in patients with shoulder impingement syndrome . Therefore , a r and omized clinical trial with a blinded assessor was used in 22 patients with shoulder impingement syndrome . The primary outcome measures included self-reported shoulder disability and pain . Next , patients were evaluated regarding scapular positioning and shoulder muscle strength . The scapular-focused treatment included stretching and scapular motor control training . The control therapy included stretching , muscle friction , and eccentric rotator cuff training . Main outcome measures were the shoulder disability question naire , diagnostic tests for shoulder impingement syndrome , clinical tests for scapular positioning , shoulder pain ( visual analog scale ; VAS ) , and muscle strength . A large clinical ly important treatment effect in favor of scapular motor control training was found in self-reported disability ( Cohen ’s d = 0.93 , p = 0.025 ) , and a moderate to large clinical ly important improvement in pain during the Neer test , Hawkins test , and empty can test ( Cohen ’s d 0.76 , 1.04 , and 0.92 , respectively ) . In addition , the experimental group demonstrated a moderate ( Cohen ’s d = 0.67 ) improvement in self-experienced pain at rest ( VAS ) , whereas the control group did not change . The effects were maintained at three months follow-up A systematic review of the literature was performed to evaluate the role of exercise in treating rotator cuff impingement and to synthesize a st and ard evidence -based rehabilitation protocol . Eleven r and omized , controlled trials ( level 1 and 2 ) evaluating the effect of exercise in the treatment of impingement were identified . Data regarding demographics , methodology , and outcomes of pain , range of motion , strength , and function were recorded . Individual components of each rehabilitation program were catalogued . Effectiveness was determined by statistical and clinical significance . Although many articles had method ologic concerns , the data demonstrate that exercise has statistically and clinical ly significant effects on pain reduction and improving function , but not on range of motion or strength . Manual therapy augments the effects of exercise , yet supervised exercise was not different than home exercise programs . Information regarding specific components of the exercise programs was synthesized into a gold st and ard rehabilitation protocol for future studies on the nonoperative treatment of rotator cuff impingement Background Subacromial impingement syndrome ( SIS ) is the most frequently recorded shoulder disorder . When conservative treatment of SIS fails , a subacromial decompression is warranted . However , the best moment of referral for surgery is not well defined . Both early and late referrals have disadvantages – unnecessary operations and smaller improvements in shoulder function , respectively . This paper describes the design of a new interdisciplinary treatment strategy for SIS ( TRANSIT ) , which comprises rules to treat SIS in primary care and a well-defined moment of referral for surgery . Methods / Design The effectiveness of an arthroscopic subacromial decompression versus usual medical care will be evaluated in a r and omized controlled trial ( RCT ) . Patients are eligible for inclusion when experiencing a recurrence of SIS within one year after a first episode of SIS which was successfully treated with a subacromial corticosteroid injection . After inclusion they will receive injection treatment again by their general practitioner . When , after this treatment , there is a second recurrence within a year post-injection , the participants will be r and omized to either an arthroscopic subacromial decompression ( intervention group ) or continuation of usual medical care ( control group ) . The latter will be performed by a general practitioner according to the Dutch National Guidelines for Shoulder Problems . At inclusion , at r and omization and three , six and 12 months post-r and omization an outcome assessment will take place . The primary outcome measure is the patient-reported Shoulder Disability Question naire . The secondary outcome measures include both disease-specific and generic measures , and an economic evaluation . Treatment effects will be compared for all measurement points by using a GLM repeated measures analyses . Discussion The rationale and design of an RCT comparing arthroscopic subacromial decompression with usual medical care for subacromial impingement syndrome are presented . The results of this study will improve insight into the best moment of referral for surgery for SIS OBJECTIVE To assess the value of search ing for unpublished data by exploring the extent to which Cochrane review s include unpublished data and by evaluating the quality of unpublished trials . STUDY DESIGN AND SETTING We screened all 2,462 completed Cochrane review s published since 2000 in the Cochrane Data base of Systematic Review s Issue 3 , 2006 . In a r and om sample ( n=61 ) of 292 review s , including unpublished trials , we studied all 116 references . RESULTS Unpublished trials make up 8.8 % of all included trials in our sample . Thirty-eight percent of the " unpublished " trials have in fact been published . Allocation concealment was " unclear " or not adequate in 54.3 % and 61.3 % reported blinding . In 47.2 % reported withdrawal rates were > 20 % . Trials that were eventually published had larger mean population sizes ( P-value , 0.02 ) . Of the reported sponsors , 87.3 % were drug companies . Method ological quality and publication bias are mentioned in half of the review s and explored in a third . Quality ratings did not have consequences for pooling , because 82.8 % was included in the forest plots . CONCLUSIONS A minority of Cochrane review s include " unpublished trials " and many of these are eventually published . Truly unpublished studies have poor or unclear method ological quality . Therefore , it may be better to invest in regular updating of review s , rather than in extensive search ing for unpublished data OBJECTIVE The study investigated the effectiveness of stretching , strengthening exercises , and the scapular stabilization exercises on the pain , shoulder range of motion ( ROM ) , muscle strength , joint position sense ( JPS ) , scapular dyskinesis and quality of life ( OL ) in the patients with subacromial impingement synd Output:

SFA for RCSP confers benefit over generalised approaches up to six weeks but this benefit is not apparent by 3 months . Early changes in pain are not clinical ly significant .

MS2_1shot458

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: To assess age and gender differences in muscle strength , isometric , concentric ( Con ) , and eccentric ( Ecc ) peak torque was measured in the knee extensors at a slow ( 0.52 rad/s ) and fast ( 3.14 rad/s ) velocity in 654 subjects ( 346 men and 308 women , aged 20 - 93 yr ) from the Baltimore Longitudinal Study of Aging . Regression analysis revealed significant ( P < 0.001 ) age-related reductions in Con and Ecc peak torque for men and women at both velocities , but no differences were observed between the gender groups or velocities . Age explained losses in Con better than Ecc peak torque , accounting for 30 % ( Con ) vs. 19 % ( Ecc ) of the variance in men and 28 % ( Con ) vs. 11 % ( Ecc ) in women . To assess age and gender differences in the ability to store and utilize elastic energy , the stretch-shortening cycle was determined in a subset of subjects ( n = 47 ) . The older women ( mean age = 70 yr ) showed a significantly greater enhancement in the stretch-shortening cycle , compared with men of similar age ( P < 0.01 ) and compared with younger men and women ( each P < 0.05 ) . Both men and women showed significant declines in muscle quality for Con peak torque ( P < 0.01 ) , but no gender differences were observed . Only the men showed a significant decline in muscle quality ( P < 0.001 ) for Ecc peak torque . Thus both men and women experience age-related losses in isometric , Con , and Ecc knee extensor peak torque ; however , age accounted for less of the variance in Ecc peak torque in women , and women tend to better preserve muscle quality with age for Ecc peak torque . In addition , older women have an enhanced capacity to store and utilize elastic energy compared with similarly aged men as well as with younger women and men To determine whether 10 weeks of whole-body vibration ( WBV ) training has a significant effect on strength , muscle mass , muscle power , and mobility in older women , 26 subjects were r and omly assigned to a WBV training group ( n=13 ; mean age 79 years ) and a control ( CON ) group ( n=13 ; mean age 76 years ) . Maximal voluntary isometric contraction ( MVIC ) increased 38.8 % in the WBV group , without changes in the CON group . Electromyographic activity of the vastus medialis ( VM ) , the vastus lateralis , and the biceps femoris ( BF ) did not change in either group . Thigh muscle cross-sectional area increased significantly after training in VM ( 8.7 % ) and BF ( 15.5 % ) . Muscle power at 20 % , 40 % , and 60 % MVIC decreased from pre-test to post-test in the CON group ; however , WBV training prevented the decrease in the WBV group . Consequently , mobility , measured by the Timed Up and Go test , increased significantly after training ( 9.0 % ) only in the WBV group . Ten weeks of lower limb WBV training in older women produces a significant increase in muscle strength induced by thigh muscle hypertrophy , with no change in muscle power . The adaptations to WBV found in the present study may be of use in counteracting the loss of muscle strength and mobility associated with age-induced sarcopenia This study examined the correlations between isokinetic muscle strength of knee and elbow flexors and extensors with vertebral and femoral bone mineral density in a population of 106 women between the ages of 44 and 87 years . The absolute value of muscle strength correlated significantly with bone mineral density ; muscle strength of the upper limb appeared to be more closely correlated with bone mass , while muscle strength in the lower limb was more specific for femoral mineral bone density . The most important finding that these results demonstrated was a concomitant decline in muscle strength of the upper limb and bone mineral density between the 5th and 6th decades . In contrast , they also showed a decline in muscle strength of the lower limbs after the 6th decade , occurring before the decline in bone mineral density observed between the 7th and 8th decades . From these results it would appear that other studies are required to examine the relationship between the essentially hormonal role in postmenopausal decline in muscle strength and the decline in physical activity during the senile period . These elements are important because they must be taken into account in physical exercise programmes design ed to prevent osteoporosis The aim was to study whether whole body vibration ( WBV ) combined with conventional resistance training ( CRT ) induces a higher increase in neuromuscular and hormonal measures compared with CRT or WBV , respectively . Twenty-eight young men were r and omized in three groups ; squat only ( S ) , combination of WBV and squat ( S+V ) and WBV only ( V ) . S+V performed six sets with eight repetitions with corresponding eight repetition maximum ( RM ) loads on the vibrating platform , whereas S and V performed the same protocol without WBV and resistance , respectively . Maximal isometric voluntary contraction ( MVC ) with electromyography ( EMG ) measurements during leg press , counter movement jump ( CMJ ) measures ( mechanical performance ) including jump height , mean power ( Pmean ) , peak power ( Ppeak ) and velocity at Ppeak ( Vppeak ) and acute hormonal responses to training sessions were measured before and after a 9-week training period . ANOVA showed no significant changes between the three groups after training in any neuromuscular variable measured [ except Pmean , S higher than V ( P<0.05 ) ] . However , applying t tests within each group revealed that MVC increased in S and S+V after training ( P<0.05 ) . Jump height , Pmean and Ppeak increased only in S , concomitantly with increased Vppeak in all groups ( P<0.05 ) . Testosterone increased during training sessions in S and S+V ( P<0.05 ) . Growth hormone ( GH ) increased in all groups but S+V showed higher responses than S and V ( P<0.05 ) . Cortisol increased only in S+V ( P<0.05 ) . We conclude that combined WBV and CRT did not additionally increase MVC and mechanical performance compared with CRT alone . Furthermore , WBV alone did not increase MVC and mechanical performance in spite of increased GH Beck BR , Norling TL : The effect of 8 mos of twice-weekly low- or higher intensity whole body vibration on risk factors for postmenopausal hip fracture . Objective : Whole body vibration is a potential therapy for age-related loss of musculoskeletal competence . Vibration has improved bone in animal models , but evidence in humans is limited . Relative efficacy of low- vs. high-intensity whole body vibration is also unknown . Our goal was to observe the effect of brief low- and higher intensity whole body vibration on risk factors for hip fracture in postmenopausal women . Design : We used an 8-mo r and omized controlled trial design to examine the influence of twice-weekly low-intensity whole body vibration ( 15 mins , 30 Hz , 0.3 g ) or higher intensity whole body vibration ( 2 × 3 mins , 12.5 Hz , 1 g ) on anthropometrics , bone ( whole body , hip , spine , forearm , and heel ) , muscle ( wall squat and chair rise ) , and balance ( t and em walk and single leg stance ) . Physical activity , daily calcium , and compliance were recorded . Effects were examined by repeated- measures analysis of covariance , controlling for age , height , weight , calcium , physical activity , compliance , and baseline values . Results : Forty-seven women ( 71.5 ± 9.0 yrs ) completed the trial . There were no between-group differences in any measure at 8 mos , but within-group effects were evident . Controls lost bone at the trochanter ( −6 % , P = 0.03 ) and lumbar spine ( −6.6 % , P = 0.02 ) , whereas whole body vibration groups did not . Whole body vibration subjects improved wall squat ( up to 120 % , P = 0.004 ) and chair rise performance ( up to 10.5 % , P = 0.05 ) . Conclusions : Eight mos of twice-weekly whole body vibration may reduce bone loss at the hip and spine and improve lower limb muscle function . These changes may translate to a decreased risk of falls and hip fracture PURPOSE The aim of this study was to investigate and to compare the effect of a 12-wk period of whole-body vibration training and resistance training on human knee-extensor strength . METHODS Sixty-seven untrained females ( 21.4 + /- 1.8 yr ) participated in the study . The whole-body vibration group ( WBV , N = 18 ) and the placebo group ( PL , N = 19 ) performed static and dynamic knee-extensor exercises on a vibration platform . The acceleration of the vibration platform was between 2.28 g and 5.09 g , whereas only 0.4 g for the PL condition . Vibration ( 35 - 40 Hz ) result ed in increased EMG activity , but the EMG signal remained unchanged in the PL condition . The resistance-training group ( RES , N = 18 ) trained knee extensors by dynamic leg-press and leg-extension exercises ( 10 - 20 RM ) . All training groups exercised 3x wk-1 . The control group ( CO , N = 12 ) did not participate in any training . Pre- and postisometric , dynamic , and ballistic knee-extensor strength were measured by means of a motor-driven dynamometer . Explosive strength was determined by means of a counter-movement jump . RESULTS Isometric and dynamic knee-extensor strength increased significantly ( P < 0.001 ) in both the WBV group ( 16.6 + /- 10.8 % ; 9.0 + /- 3.2 % ) and the RES group ( 14.4 + /- 5.3 % ; 7.0 + /- 6.2 % ) , respectively , whereas the PL and CO group showed no significant ( P > 0.05 ) increase . Counter-movement jump height enhanced significantly ( P < 0.001 ) in the WBV group ( 7.6 + /- 4.3 % ) only . There was no effect of any of the interventions on maximal speed of movement , as measured by means of ballistic tests . CONCLUSIONS WBV , and the reflexive muscle contraction it provokes , has the potential to induce strength gain in knee extensors of previously untrained females to the same extent as resistance training at moderate intensity . It was clearly shown that strength increases after WBV training are not attributable to a placebo effect Background : It has been unclear which training mode is most effective and feasible for improving physical performance in the risk group of prefrail community-dwelling older adults . Objective : The purpose of the present study was to compare the effects of strength training ( ST ) versus power training ( PT ) on functional performance in prefrail older adults . This study was registered at clinical trials.gov as NCT00783159 . Methods : 69 community-dwelling older adults ( > 65 years ) who were prefrail according to the definition of Fried were included in a 12-week exercise program . The participants were r and omized into an ST group , a PT group and a control group . All participants were supplemented with vitamin D3 orally before entering the intervention period . The primary outcome was the global score on the Short Physical Performance Battery ( SPPB ) . Secondary outcomes were muscle power , appendicular lean mass ( aLM ) measured by dual energy X-ray absorptiometry and self-reported functional deficits ( Short Form of the Late-Life Function and Disability Instrument , SF-LLFDI ) . Results : Regarding changes in the SPPB score during the intervention , significant heterogeneity between the groups was observed ( p = 0.023 ) . In pair-wise comparisons , participants in both training groups significantly ( PT : p = 0.012 , ST : 0.009 ) increased their SPPB score ( PT : Δmean = 0.8 , ST : Δmean = 1.0 ) compared to the control group , with no statistical difference among training groups ( p = 0.301 ) . No statistical differences were found in changes in aLM ( p = 0.769 ) , muscle power ( p = 0.308 ) and SF-LLFDI ( p = 0.623 ) between the groups . Muscle power significantly increased ( p = 0.017 ) under vitamin D3 intake . Conclusions : In prefrail community-dwelling adults , PT is not superior to ST , although both training modes result ed in significant improvements in physical performance . With regard to dropout rates , ST appears to be advantageous compared to PT . The high prevalence of vitamin D3 deficiency and the slight improvement of physical performance under vitamin D3 supplementation among study participants underline the relevance of this approach in physical exercise interventions UNLABELLED High-frequency mechanical strain seems to stimulate bone strength in animals . In this r and omized controlled trial , hip BMD was measured in postmenopausal women after a 24-week whole body vibration ( WBV ) training program . Vibration training significantly increased BMD of the hip . These findings suggest that WBV training might be useful in the prevention of osteoporosis . INTRODUCTION High-frequency mechanical strain has been shown to stimulate bone strength in different animal models . However , the effects of vibration exercise on the human skeleton have rarely been studied . Particularly in postmenopausal women-who are most at risk of developing osteoporosis-r and omized controlled data on the safety and efficacy of vibration loading are lacking . The aim of this r and omized controlled trial was to assess the musculoskeletal effects of high-frequency loading by means of whole body vibration ( WBV ) in postmenopausal women . MATERIAL S AND METHODS Se Output:

No significant improvements in lean mass with WBVT were found in postmenopausal women . In addition , there was no significant difference in lean mass between WBVT and control postmenopausal women . Conclusions : This meta- analysis demonstrated that WBVT alone may not be a sufficient stimulus to increase lean mass in postmenopausal women .

MS2_1shot459

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Abstract Haloperidol treatment has been shown to produce oxidative stress in patients with acute psychosis . Oxidative stress has also been implicated in the extrapyramidal symptoms ( EPS ) produced by haloperidol . Supporting the oxidative stress hypothesis , vitamin E ( antioxidant ) has demonstrated therapeutic efficacy in idiopathic parkinsonism . The prophylactic efficacy of vitamin E ( antioxidant ) on haloperidol-induced EPS was examined in a r and omized controlled trial . The sample consisted of 24 acute psychotic patients hospitalized for a 2-week trial . All patients received oral haloperidol 10 mg/day . The sample was equally r and omized to receive either haloperidol alone or haloperidol + vitamin E ( 3200 IU/day ) . EPS was rated at recruitment , both live and with video records , and on days 3 , 7 , 10 and 14 . Psychopathology was rated at recruitment and weekly thereafter . Vitamin E had no prophylactic effect on drug-induced EPS , though it did not interfere with the therapeutic efficacy of haloperidol It has been suggested that the extract of gingko biloba ( EGb ) may enhance the efficiency of the classic antipsychotic haloperidol in patients with chronic schizophrenia , especially on positive symptoms , and reduce serum superoxide dismutase ( SOD ) levels . Therefore , we decided to evaluate the therapeutic effect of EGb and to examine the effect of it on the levels of antioxidant enzymes in schizophrenic patients on olanzapine treatment . We hypothesized that EGb would have the beneficial effects on schizophrenic symptoms and might cause reductions in antioxidant enzymes . The subjects were r and omly assigned to the two groups : olanzapine plus EGb ( group I ) ( n=15 ) and olanzapine alone ( group II ) ( n=14 ) . The patients were evaluated at baseline and at week 8 with respect to the Positive and Negative Syndrome Scale ( PANSS ) , serum SOD , catalase ( CAT ) , and glutathion peroxidase ( GPX ) levels . At baseline , no statistically significant difference regarding the mean total PANSS scores between treatment groups was found . At the evaluation of week 8 , a significant difference in mean Scale for the Assessment of Postive Symptoms ( SAPS ) scores but not in Scale for the Assessment of Negative Symptoms scores between groups was found . Total patients had statistically significant higher serum SOD , CAT and GPX levels compared to control groups at baseline . At 8 weeks , there were significant differences in the mean decrease in SOD and CAT levels but not in GPX levels between treatment groups . The changes in SOD and CAT levels were correlated with the change in SAPS in group I , but not in the group II . The present study supported the findings of the previous study demonstrating that EGb might enhance the efficiency of antipsychotic in patients with schizophrenia , particularly on positive symptoms of the disorder OBJECTIVE Despite the frequent use of the Positive and Negative Syndrome Scale ( PANSS ) for rating the symptoms of schizophrenia , the clinical meaning of its total score and of the cut-offs that are used to define treatment response ( e.g. at least 20 % or 50 % reduction of the baseline score ) are as yet unclear . We therefore compared the PANSS with simultaneous ratings of Clinical Global Impressions ( CGI ) . METHOD PANSS and CGI ratings at baseline ( n = 4091 ) , and after one , two , four and six weeks of treatment taken from a pooled data base of seven pivotal , multi-center antipsychotic drug trials on olanzapine or amisulpride in patients with exacerbations of schizophrenia were compared using equipercentile linking . RESULTS Being considered " mildly ill " according to the CGI approximately corresponded to a PANSS total score of 58 , " moderately ill " to a PANSS of 75 , " markedly ill " to a PANSS of 95 and severely ill to a PANSS of 116 . To be " minimally improved " according to the CGI score was associated with a mean percentage PANSS reduction of 19 % , 23 % , 26 % and 28 % at weeks 1 , 2 , 4 and 6 , respectively . The corresponding figures for a CGI rating " much improved " were 40 % , 45 % , 51 % and 53 % . CONCLUSIONS The results provide a better framework for underst and ing the clinical meaning of the PANSS total score in drug trials of schizophrenia patients with acute exacerbations . Such studies may ideally use at least a 50 % reduction from baseline cut-off to define response rather than lower thresholds . In treatment resistant population s , however , even a small improvement can be important , so that a 25 % cut-off might be appropriate BACKGROUND Antipsychotics remain the mainstay of drug intervention in the management of schizophrenia . However , long-term treatment with antipsychotics is associated with a variety of movement disorders , the most disabling of which is tardive dyskinesia ( TD ) , which occurs in up to 50 % of patients hospitalized with chronic schizophrenia . The pathophysiology of TD is still unclear and no definite treatment exists . Both dopamine receptor supersensitivity and oxidative stress-induced neurotoxicity in the nigrostriatal system are apparently implicated . The pineal hormone melatonin is a potent antioxidant and attenuates dopaminergic activity in the striatum and dopamine release from the hypothalamus . Thus , it may have a beneficial effect for both the treatment and prevention of TD . METHODS Using a double-blind , placebo-controlled , crossover study , we evaluated the efficacy of 10 mg/d of melatonin for 6 weeks in 22 patients with schizophrenia and TD . The primary outcome measure was the change from baseline in Abnormal Involuntary Movement Scale ( AIMS ) score . RESULTS The decrease ( mean + /- SD ) in AIMS score was 2.45 + /- 1.92 for the melatonin and 0.77 + /- 1.11 for the placebo treatment groups ( P<.001 ) . No adverse events or side effects were noted . CONCLUSION This is the first clinical evidence for efficacy of melatonin in the treatment of TD Adherence to prescribed medications is believed to be a major problem in medicine . However , actual medication taking behaviour is rarely measured as no reliable objective measures of adherence are available . 50 mg of riboflavin administered at night could be reliably detected in urine , under UV light , for the next 18 - 24 h. The ability of 20 schizophrenic out patients to adhere to a once-a-night dosage was studied by dispensing riboflavin or placebo in a r and om sequence and testing the urine for UV fluorescence the next day . The majority of patients ( 80 % ) had errors between 40 - 80 % of the times tested . Only age and sex predicted the level of adherence . Clinicians were very poor predictors of the error rates in their patients The purpose of the study was to evaluate the effect of the classic antipsychotic haloperidol plus extract of ginkgo biloba ( EGb ) on treatment-resistant chronic schizophrenia and on blood superoxide dismutase ( SOD ) levels . Eighty-two patients with chronic refractory schizophrenia were studied . Forty-three patients were treated with haloperidol plus extract of ginkgo biloba ( group 1 ) , and 39 received haloperidol plus placebo ( group 2 ) . SOD levels of these patients were measured before and after treatment and were compared with SOD levels of 30 healthy volunteers . Therapeutic efficiency was equated with a change in clinical rating scores assessed by st and ardized measurement tools that included the Scale for the Assessment of Positive Symptoms and the Scale for the Assessment of Negative Symptoms ( SANS ) over this period . Patients in group 1 improved significantly as demonstrated by scores from these two assessment instruments ; those in group 2 improved significantly only as shown by scores on SANS . SOD levels before treatment in all patients were significantly higher than those in healthy controls ; after treatment , the SOD level decreased significantly in group 1 but not in group 2 . These results suggest that EGb may enhance the efficiency of the classic antipsychotic haloperidol in patients with schizophrenia , especially on their positive symptoms , and that EGb may work through an antioxidant effect that is involved in the therapeutic mechanism in patients with chronic refractory schizophrenia BACKGROUND Pathomorphologic brain changes occurring as early as first-episode schizophrenia have been extensively described . Longitudinal studies have demonstrated that these changes may be progressive and associated with clinical outcome . This raises the possibility that antipsychotics might alter such pathomorphologic progression in early-stage schizophrenia . OBJECTIVE To test a priori hypotheses that olanzapine-treated patients have less change over time in whole brain gray matter volumes and lateral ventricle volumes than haloperidol-treated patients and that gray matter and lateral ventricle volume changes are associated with changes in psychopathology and neurocognition . DESIGN Longitudinal , r and omized , controlled , multisite , double-blind study . Patients treated and followed up for up to 104 weeks . Neurocognitive and magnetic resonance imaging ( MRI ) assessment s performed at weeks 0 ( baseline ) , 12 , 24 , 52 , and 104 . Mixed-models analyses with time-dependent covariates evaluated treatment effects on MRI end points and explored relationships between MRI , psychopathologic , and neurocognitive outcomes . SETTING Fourteen academic medical centers ( United States , 11 ; Canada , 1 ; Netherl and s , 1 ; Engl and , 1 ) . PARTICIPANTS Patients with first-episode psychosis ( DSM-IV ) and healthy volunteers . INTERVENTIONS R and om allocation to a conventional antipsychotic , haloperidol ( 2 - 20 mg/d ) , or an atypical antipsychotic , olanzapine ( 5 - 20 mg/d ) . MAIN OUTCOME MEASURES Brain volume changes assessed by MRI . RESULTS Of 263 r and omized patients , 161 had baseline and at least 1 postbaseline MRI evaluation . Haloperidol-treated patients exhibited significant decreases in gray matter volume , whereas olanzapine-treated patients did not . A matched sample of healthy volunteers ( n = 58 ) examined contemporaneously showed no change in gray matter volume . CONCLUSIONS Patients with first-episode psychosis exhibited a significant between-treatment difference in MRI volume changes . Haloperidol was associated with significant reductions in gray matter volume , whereas olanzapine was not . Post hoc analyses suggested that treatment effects on brain volume and psychopathology of schizophrenia may be associated . The differential treatment effects on brain morphology could be due to haloperidol-associated toxicity or greater therapeutic effects of olanzapine BACKGROUND Brain glutathione levels are decreased in schizophrenia , a disorder that often is chronic and refractory to treatment . N-acetyl cysteine ( NAC ) increases brain glutathione in rodents . This study was conducted to evaluate the safety and effectiveness of oral NAC ( 1 g orally twice daily [ b.i.d . ] ) as an add-on to maintenance medication for the treatment of chronic schizophrenia over a 24-week period . METHODS A r and omized , multicenter , double-blind , placebo-controlled study . The primary readout was change from baseline on the Positive and Negative Symptoms Scale ( PANSS ) and its components . Secondary readouts included the Clinical Global Impression ( CGI ) Severity and Improvement scales , as well as general functioning and extrapyramidal rating scales . Changes following a 4-week treatment discontinuation were evaluated . One hundred forty people with chronic schizophrenia on maintenance antipsychotic medication were r and omized ; 84 completed treatment . RESULTS Intent-to-treat analysis revealed that subjects treated with NAC improved more than placebo-treated subjects over the study period in PANSS total [ -5.97 ( -10.44 , -1.51 ) , p = .009 ] , PANSS negative [ mean difference -1.83 ( 95 % confidence interval : -3.33 , -.32 ) , p = .018 ] , and PANSS general [ -2.79 ( -5.38 , -.20 ) , p = .035 ] , CGI-Severity ( CGI-S ) [ -.26 ( -.44 , -.08 ) , p = .004 ] , and CGI-Improvement ( CGI-I ) [ -.22 ( -.41 , -.03 ) , p = .025 ] scores . No significant change on the PANSS positive subscale was seen . N-acetyl cysteine treatment also was associated with an improvement in akathisia ( p = .022 ) . Effect sizes at end point were consistent with moderate benefits . CONCLUSIONS These data suggest that adjunctive NAC has potential as a safe and moderately effective augmentation strategy for chronic schizophrenia OBJECTIVE The authors ' goal was to test the efficacy of selegiline augmentation of antipsychotic medication in out patients with schizophrenia who had negative symptoms of moderate or greater severity . METHOD A 12-week , double-blind , placebo-controlled , multicenter trial of oral selegiline augmentation Output:

Adverse events were generally poorly reported . No evidence was available for relapse , quality of life or service use .

MS2_1shot460

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: The aim of this trial was to compare multimodal optimization with conventional perioperative management in a consecutive series of patients undergoing a wide range of colorectal procedures BACKGROUND Minimally invasive , laparoscopically assisted surgery was first considered in 1990 for patients undergoing colectomy for cancer . Concern that this approach would compromise survival by failing to achieve a proper oncologic resection or adequate staging or by altering patterns of recurrence ( based on frequent reports of tumor recurrences within surgical wounds ) prompted a controlled trial evaluation . METHODS We conducted a noninferiority trial at 48 institutions and r and omly assigned 872 patients with adenocarcinoma of the colon to undergo open or laparoscopically assisted colectomy performed by credentialed surgeons . The median follow-up was 4.4 years . The primary end point was the time to tumor recurrence . RESULTS At three years , the rates of recurrence were similar in the two groups--16 percent among patients in the group that underwent laparoscopically assisted surgery and 18 percent among patients in the open-colectomy group ( two-sided P=0.32 ; hazard ratio for recurrence , 0.86 ; 95 percent confidence interval , 0.63 to 1.17 ) . Recurrence rates in surgical wounds were less than 1 percent in both groups ( P=0.50 ) . The overall survival rate at three years was also very similar in the two groups ( 86 percent in the laparoscopic-surgery group and 85 percent in the open-colectomy group ; P=0.51 ; hazard ratio for death in the laparoscopic-surgery group , 0.91 ; 95 percent confidence interval , 0.68 to 1.21 ) , with no significant difference between groups in the time to recurrence or overall survival for patients with any stage of cancer . Perioperative recovery was faster in the laparoscopic-surgery group than in the open-colectomy group , as reflected by a shorter median hospital stay ( five days vs. six days , P<0.001 ) and briefer use of parenteral narcotics ( three days vs. four days , P<0.001 ) and oral analgesics ( one day vs. two days , P=0.02 ) . The rates of intraoperative complications , 30-day postoperative mortality , complications at discharge and 60 days , hospital readmission , and reoperation were very similar between groups . CONCLUSIONS In this multi-institutional study , the rates of recurrent cancer were similar after laparoscopically assisted colectomy and open colectomy , suggesting that the laparoscopic approach is an acceptable alternative to open surgery for colon cancer BACKGROUND Although laparoscopic resection of colorectal carcinoma improves post-operative recovery , long-term survival and disease control are the determining factors for its application . We aim ed to test the null hypothesis that there was no difference in survival after laparoscopic and open resection for rectosigmoid cancer . METHODS From Sept 21 , 1993 , to Oct 21 , 2002 , 403 patients with rectosigmoid carcinoma were r and omised to receive either laparoscopic assisted ( n=203 ) or conventional open ( n=200 ) resection of the tumour . Survival and disease-free interval were the main endpoints . Patients were last followed-up in March , 2003 . Perioperative data were recorded and direct cost of operation estimated . Data were analysed by intention to treat . FINDINGS The demographic data of the two groups were similar . After curative resection , the probabilities of survival at 5 years of the laparoscopic and open resection groups were 76.1 % ( SE 3.7 % ) and 72.9 % ( 4.0 % ) respectively . The probabilities of being disease free at 5 years were 75.3 % ( 3.7 % ) and 78.3 % ( 3.7 % ) , respectively . The operative time of the laparoscopic group was significantly longer , whereas postoperative recovery was significantly better than for the open resection group , but these benefits were at the expense of higher direct cost . The distal margin , the number of lymph nodes found in the resected specimen , overall morbidity and operative mortality did not differ between groups . INTERPRETATION Laparoscopic resection of rectosigmoid carcinoma does not jeopardise survival and disease control of patients . The justification for adoption of laparoscopic technique would depend on the perceived value of its effectiveness in improving short-term post-operative outcomes Background : To evaluate the feasibility of a fast-track ( FT ) program and it ’s effect on postoperative recovery . Methods : All patients , scheduled for elective segmental colorectal resection were treated in a FT program ( FT group ) . Data were compared to a control group operated for elective colorectal resections and treated in a traditional care program ( TC group ) . Data from the FT group were collected prospect ively , data from the TC group retrospectively . Outcome parameters included the number of successfully applied FT modalities , patient satisfaction , morbidity rate , re-operation rate , primary ( PHS ) and total hospital stay ( THS ) , and readmission rate . Results : One-hundred and seven patients were included ( 55 FT group vs. 52 TC group ) . The groups were comparable for patient characteristics such as age and cr-POSSUM score ( p = 0.22 and p = 0.40 ) . An average of 7.4 of 13 predefined FT modalities were successfully achieved per patient . Patient satisfaction was comparable ( p = 0.84 ) . Seven versus 5 patients required a re-operation in the FT and TC groups , respectively ( p = 0.52 ) . Morbidity rate was comparable ( n = 16 vs. 15 , p = 0.83 ) . Median PHS was 4.0 vs. 6.0 days and median THS was 4.0 vs. 6.5 days in the FT and TC groups ( p < 0.01 and p < 0.03 , respectively ) . Six vs. 3 patients were re-admitted in the FT and TC groups , respectively ( p = 0.49 ) . Conclusion : Implementation of all FT modalities was difficult since a rather low number of pre-defined FT modalities was effectively realized . Despite incomplete implementation , PHS and THS were shorter in the FT group without affecting patient satisfaction Multimodal optimization of surgical care has been associated with reduced hospital stay and improved physical function . The aim of this r and omized trial was to compare multimodal optimization with st and ard care in patients undergoing colonic resection OBJECTIVE To investigate the feasibility of a 48-hour postoperative stay program after colonic resection . SUMMARY BACKGROUND DATA Postoperative hospital stay after colonic resection is usually 6 to 12 days , with a complication rate of 10 % to 20 % . Limiting factors for early recovery include stress-induced organ dysfunction , paralytic ileus , pain , and fatigue . It has been hypothesized that an accelerated multimodal rehabilitation program with optimal pain relief , stress reduction with regional anesthesia , early enteral nutrition , and early mobilization may enhance recovery and reduce the complication rate . METHODS Sixty consecutive patients undergoing elective colonic resection were prospect ively studied using a well-defined postoperative care program including continuous thoracic epidural analgesia and enforced early mobilization and enteral nutrition , and a planned 48-hour postoperative hospital stay . Postoperative follow-up was scheduled at 8 and 30 days . RESULTS Median age was 74 years , with 20 patients in ASA group III-IV . Normal gastrointestinal function ( defecation ) occurred within 48 hours in 57 patients , and the median hospital stay was 2 days , with 32 patients staying 2 days after surgery . There were no cardiopulmonary complications . The readmission rate was 15 % , including two patients with anastomotic dehiscence ( one treated conservatively , one with colostomy ) ; other readmissions required only short-term observation . CONCLUSION A multimodal rehabilitation program may significantly reduce the postoperative hospital stay in high-risk patients undergoing colonic resection . Such a program may also reduce postoperative ileus and cardiopulmonary complications . These results may have important implication s for the care of patients after colonic surgery and in the future assessment of open versus laparoscopic colonic resection INTRODUCTION Laparoscopic ( LAP ) versus open ( CON ) colonic resection with traditional perioperative care has some short term benefits postoperatively regarding functional recovery . Whether these benefits may also occur when all patients are treated with multimodal " fast-track"-rehabilitation programs is question able . METHODS Patients undergoing elective left sided colonic surgery were prospect ively non r and omised observed . The " fast-track " program included patient information , thoracic peridural analgesia , forced mobilisation and oral intake , and stress reduction . Endpoints were duration of postoperative ileus and hospital stay , general- and local complication , and pulmonary function . RESULTS 147 consecutive patients were operated on , 47 open and 100 laparoscopically . The time until oral intake was completed seemed to be shorter in the LAP-group ( p=0.07 ) followed by a shorter hospital stay ( p<0.01 ) . The pulmonary function was postoperatively improved in the LAP-group compared to the CON-group ( p<0,01 ) . General complications ( LAP 9 % vs. CON 17 % ) were non significantly increased in the CON-group . Local complications increased in the CON-group ( LAP 13 % vs. CON 28 % , p<0,05 ) . CONCLUSION Even with perioperative " fast-track"-rehabilitation programs short term advantages were found in laparoscopic compared with open colonic surgery in a non r and omised population . The clinical relevance should be examined in controlled r and omised trials Abstract INTRODUCTION : In an era of dwindling hospital re sources and increasing medical costs , safe reduction in postoperative stay has become a major focus to optimize utilization of healthcare re sources . Although several protocol s have been reported to reduce postoperative stay , no Level I evidence exists for their use in routine clinical practice . METHODS : Sixty-four patients undergoing laparotomy and intestinal or rectal resection were r and omly assigned to a pathway of controlled rehabilitation with early ambulation and diet or to traditional postoperative care . Time to discharge from hospital , complication and readmission rates , pain level , quality of life , and patient satisfaction scores were determined at the time of discharge and at 10 and 30 days after surgery . Subgroups were defined to evaluate those who derived the optimal benefit from the protocol . RESULTS : Pathway patients spent less total time in the hospital after surgery ( 5.4 vs. 7.1 days ; P = 0.02 ) and less time in the hospital during the primary admission than traditional patients . Patients younger than 70 years old had greater benefits than the overall study group ( 5 vs. 7.1 days ; P = 0.01 ) . Patients treated by surgeons with the most experience with the pathway spent significantly less time in the hospital than did those whose surgeons were less experienced with the pathway ( P = 0.01 ) . There was no difference between pathway and traditional patients for readmission or complication rates , pain score , quality of life after surgery , or overall satisfaction with the hospital stay . CONCLUSIONS : Patients scheduled for a laparotomy and major intestinal or rectal resection are suitable for management by a pathway of controlled rehabilitation with early ambulation and diet . Pathway patients have a shorter hospital stay , with no adverse effect on patient satisfaction , pain scores , or complication rates . Patients younger than 70 years of age derive the optimal benefit , and increased surgeon experience improves outcome BACKGROUND Multimodal postoperative care regimens accelerate recovery after abdominal surgery . The benefit of thoracic epidural ( TE ) analgesia over patient-controlled analgesia ( PCA ) remains unproven when used with a fast-track postoperative care plan . METHODS Fifty-six patients undergoing major intestinal resection , and on a fast-track postoperative care plan , were r and omized to preemptive TE or PCA . Patients were evaluated at st and ard time points for pain score , quality of life ( Short Form-36 ) , and complications . Oral analgesia was substituted for TE and PCA on the second postoperative day . Discharge criteria were identical for both groups . RESULTS Six patients ( 20.6 % ) had a failed epidural . There was no difference in length of stay ( 5.8 versus 6.2 days , TE versus PCA , P = .55 ) , total length of stay ( including readmissions ) , pain scores , quality of life , complications , or hospital costs at any time point . CONCLUSION TE offers no advantage over PCA for patients undergoing major intestinal resections who are on a fast-track postoperative care plan using PCA Objective The primary endpoint was to compare the impact of laparoscopic and open colorectal surgery on 30-day postoperative morbidity . Lymphocyte proliferation to mitogens and gut oxygen tension were surrogate endpoints . Summary Background Data Evidence -based proof of the effect of laparoscopic colorectal surgery on immunometabolic response and clinical ly relevant outcome variables is scanty . Further r and omized trials are desirable before proposing laparoscopy as a superior technique . Methods Two hundred sixty-nine patients with colorectal disease were r and omly assigned to laparoscopic ( n = 136 ) or open ( n = 133 ) colorectal resection . Four trained members of the surgical staff who were not involved in the study registered postoperative complications . L Output:

There were no significant differences in mortality rates .

MS2_1shot461

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: OBJECTIVE To determine whether arthrographic distension with a mixture of saline and steroid , in patients with painful stiff shoulder for at least 3 months , is better than placebo in improving function , pain , and range of motion at 3 , 6 , and 12 weeks . METHODS A r and omised , placebo controlled trial with participant and outcome assessor blinding in which shoulder joint distension with normal saline and corticosteroid was compared with placebo ( arthrogram ) . Outcome measures , assessed at 3 , 6 , and 12 weeks , included a shoulder-specific disability measure ( SPADI ) , a patient preference measure ( Problem Elicitation Technique ( PET ) ) , pain , and range of active motion . RESULTS From 96 potential participants , 48 were recruited . Four withdrew from the placebo group after the 3 week assessment and three subsequently received arthrographic distension with saline and steroid . At 3 weeks , significantly greater improvement in SPADI ( p = 0.005 ) , PET , overall pain , active total shoulder abduction , and h and behind back was found in participants in the joint distension and steroid group than in the placebo group . At 6 weeks the results of the intention to treat analysis favoured joint distension , although the between-group differences were only significant for improvement in PET ( difference in mean change in PET between groups = 45.9 ( 95 % CI 3.2 to 88.7 ) . Excluding the four withdrawals , the between-group differences for the disability and pain measures significantly favoured distension over placebo . At 12 weeks , both the intention to treat analysis and an analysis excluding the four withdrawals demonstrated a significantly greater improvement in PET score for the distension group . CONCLUSIONS Short term efficacy of arthrographic distension with normal saline and corticosteroid over placebo was demonstrated in patients with painful stiff shoulder OBJECTIVE To study the effect of accuracy on the clinical outcome of local steroid injections to the shoulder . METHODS 37 patients with shoulder symptoms of at least two months ’ duration received local injections of a mixture of triamcinolone and radiographic contrast material using a st and ardised technique . Radiographs of the joint were taken immediately afterwards . Details of the patients ’ symptoms ( assessed by visual analogue scales ) and range of movement at the joint were obtained before and two weeks after the injection . At follow up the patients were also assessed by means of a five point global rating scale of maximum and current benefit . RESULTS 14 of the 38 procedures ( 37 % ) were judged to be accurately placed : four of the 14 attempted subacromial injections ( 29 % ) and 10 of the 24 attempted glenohumeral injections ( 42 % ) . There were significant differences in relation to outcome between the accurately placed and the inaccurately placed groups . CONCLUSIONS Accuracy of steroid placement by injection in patients with shoulder symptoms may significantly affect the clinical outcome Background Blind injection of the subacromial-sub-deltoid bursa ( SSB ) for diagnostic purpose s ( Neer test ) or therapeutic purpose s ( corticosteroid therapy ) is frequently used . Poor response to previous blind injection or side effects may be due to a misplaced injection . It is assumed that ultrasound (US)-guided injections are more accurate than blind injections . In a r and omized study , we compared the accuracy of blind injection to that of US-guided injection into the SSB . Patients and methods 20 consecutive patients with impingement syndrome of the shoulder were r and omized for blind or US-guided injection in the SSB . Injection was performed either by an experienced orthopedic surgeon or by an experienced musculoskeletal radiologist . A mixture of 1 m’L methylprednisolone acetate , 4 mL prilocaine hydrochloride and 0.02 mL ( 0.01 mmol ) Gadolinium DTPA was injected . Immediately after injection , a 3D-gradient T1-weighted magnetic resonance scan of the shoulder was performed . The location of the injected fluid was independently assessed by 2 radiologists who were blinded as to the injection technique used . Results The accuracy of blind and US-guided injection was the same . The fluid was injected into the bursa in all cases . Interpretation Blind injection into the SSB is as reliable as US-guided injection and could therefore be used in daily routine . US-guided injections may offer a useful alternative in difficult cases , such as with changed anatomy postoperatively or when there is no effective clinical outcome The histological changes found in the supraspinatus tendon have similarities with the findings in Achilles- , patellar- and extensor carpi radialis brevis (ECRB)-tendinopathy . In recent studies , we have found a vasculo-neural ingrowth in chronic painful Achilles and patellar tendinopathy , and demonstrated good short-term clinical effects with injections of the sclerosing substance polidocanol . In this collaborative two-centre pilot study , 15 patients ( 10 males and 5 females , mean age 46 years ) with a long duration of shoulder pain ( mean 28 months ) , and given the diagnosis chronic painful shoulder impingement syndrome , were included . They had tried rest , traditional rehabilitation exercises and multiple subacromial corticosteroid injections , without effect . We found vascularity ( neovessels ) in chronic painful , but not in pain-free , supraspinatus tendons , and prospect ively studied the clinical effects of ultrasound ( US ) and colour Doppler (CD)-guided injections of polidocanol , targeting the area with neovessels . The patients evaluated the amount of shoulder pain during horizontal shoulder activity on a visual analogue scale ( VAS ) , and satisfaction with treatment . Two ( median ) ( range 1–5 ) polidocanol treatments ( with 4–8 weeks in between ) were given . In four patients ( considered treatment failure ) , cortisone was injected into an inflamed subacromial bursa at one separate occasion weeks after the last polidocanol injection . At follow-up , 8 ( median ) ( range 4–17 ) months after the treatment , 14 patients were satisfied with the result . Using the visual analogue scale evaluation ( VAS ) , the pain dropped from 79 before treatment to 21 at follow-up ( P < 0.05 ) . In the short-term perspective , sclerosing polidocanol injections targeting the neovessels in the supraspinatus tendon and /or bursa wall seems to have a potential to reduce the pain during shoulder loading activity Background Hydrodilatation of the glenohumeral joint is by several authors reported to improve shoulder pain and range of motion for patients with adhesive capsulitis . Procedures described often involve the injection of corticosteroids , to which the reported treatment effects may be attributed . Any important contribution arising from the hydrodilatation procedure itself remains to be demonstrated . Methods In this r and omized trial , a hydrodilatation procedure including corticosteroids was compared with the injection of corticosteroids without dilatation . Patients were given three injections with two-week intervals , and all injections were given under fluoroscopic guidance . Outcome measures were the Shoulder Pain and Disability Index ( SPADI ) and measures of active and passive range of motion . Seventy-six patients were included and groups were compared six weeks after treatment . The study was design ed as an open trial . Results The groups showed a rather similar degree of improvement from baseline . According to a multiple regression analysis , the effect of dilatation was a mean improvement of 3 points ( confidence interval : -5 to 11 ) on the SPADI 0–100 scale . T-tests did not demonstrate any significant between-group differences in range of motion . Conclusion This study did not identify any important treatment effects result ing from three hydrodilatations that included steroid compared with three steroid injections alone . Trial registration The study is registered in Current Controlled Trials with the registration number IS RCT N90567697 PURPOSE The study goal was to examine the targeting accuracy of subacromial injection to the shoulder and the influence of the location of the injected structure . TYPE OF STUDY A prospect i ve nonr and omized study . METHODS Fifty-three patients ( 56 shoulders ; 34 women and 19 men ; mean age , 74.5 years ; range , 49 to 91 ) with impingement signs ( Neer , Hawkins ) of at least 2 months ' duration received a subacromial injection of a mixture of 0.5 mL ( 2.5 mg ) betamethasone acetate and 3 mL of radiographic contrast material ( iotrolan ) and 7 mL of 1 % lidocaine using a lateral approach . Radiographs of the shoulder joint were taken immediately after the injection to determine the structure reached by the injection . Details of pain expressed as Neer and Hawkins impingement signs were obtained before and 15 minutes after the injection , and subjectively assessed using a 4-point self-administered pain score . Pain reduction result ing from subacromial and intradeltoid injection was compared . RESULTS Thirty-nine of the 56 injections ( 70 % ) were judged to have reached the subacromial bursa . Twelve ( 21 % ) were seen to have entered the deltoid muscle ; 2 ( 4 % ) were in the glenohumeral joint ; and 3 ( 5 % ) were subcutaneous . A comparison of subacromial bursal with intradeltoid injection showed no significant differences in pain reduction expressed as impingement signs ( 1.5 vs 1.7 in the Neer impingement sign and 1.6 vs 1.6 in the Hawkins impingement sign , respectively ) . CONCLUSIONS This study showed that subacromial injection was a relatively difficult procedure . A high incidence of injections that missed the subacromial bursa would be a sufficient reason to refrain from repeated usage of corticosteroids . These results also suggest that pain relief could be attained whether the injected material reached the subacromial bursa or the deltoid muscle . Successful pain relief after intradeltoid injection seems to call into question the diagnostic value of a positive Neer impingement test Twenty-six patients with frozen shoulder syndrome ( Stage 2 and 3 ) were included in this study conducted at Dr. Kariadi General Hospital , Semarang , Indonesia and r and omly allocated into 2 groups : 40 mg triamcinolone intra-articular injection and triamcinolone oral tablets . The result showed that triamcinolone intra-articular injection group " cured " rate was 5.8 times higher at week one compared to the triamcinolone tablet group . Sixty-two percent of the cases with triamcinolone intra-articular injection achieved their " cured " condition after one week of therapy , compared with only 14 % of the triamcinolone tablets group . We conclude that , intra-articular corticosteroid injection provide faster improvement compared to oral route Objective To compare the effectiveness of ultrasound guided corticosteroid injection in the subacromial bursa with systemic corticosteroid injection in patients with rotator cuff disease . Design Double blind r and omised clinical trial . Setting Outpatient clinic of a physical medicine and rehabilitation department in Oslo , Norway . Patients 106 patients with rotator cuff disease lasting at least three months . Interventions Ultrasound guided corticosteroid and lidocaine injection in the subacromial bursa and lidocaine injection in the gluteal region ( local group ) ; corticosteroid and lidocaine injection in the gluteal region and ultrasound guided lidocaine injection in the subacromial bursa ( systemic group ) . Main outcome measures Difference in improvement in the overall shoulder pain and disability index score after six weeks . Results Six weeks after the intervention , the mean difference in improvement in overall shoulder pain and disability index score between the local group and the systemic group was −5.2 ( 95 % confidence interval −13.9 to 3.5 ) ; it was −4.1 ( −12.3 to 4.1 , P=0.32 ) after adjustment for baseline score . A small but statistically significant difference in improvement between groups occurred in favour of the local group for two secondary outcome measures : the Western Ontario rotator cuff index ( 8.1 , 0.7 to 15.6 ) and change in main complaint ( 2.0 , 0 to 4 ) . Conclusions No important differences in short term outcomes were found between local ultrasound guided corticosteroid injection and systemic corticosteroid injection in rotator cuff disease . Trial registration Clinical trials NCT00640575 Objective To determine whether fluoroscopic guidance improves outcomes of injections for greater trochanteric pain syndrome . Design Multicentre double blind r and omised controlled study . Setting Three academic and military treatment facilities in the United States and Germany . Participants 65 patients with a clinical diagnosis of greater trochanteric pain syndrome . Interventions Injections of corticosteroid and local anaesthetic into the trochanteric bursa , using fluoroscopy ( n=32 ) or l and marks ( that is , “ blind ” injections ; n=33 ) for guidance . Main outcome measures Primary outcome measures : 0 - 10 numerical rating scale pain scores at rest and with activity at one month ( positive categorical outcome predefined as ≥50 % pain reduction either at rest or with activity , coupled with positive global perceived effect ) . Secondary outcome measures included Oswestry disability scores , SF-36 scores , reduction in drug use , and patients ’ satisfaction . Results No differences in outcomes occurred favouring either the fluoroscopy or blind treatment groups . One month after injection the average pain scores were 2.7 at rest and 5.0 with activity in the fluoroscopy group compared with 2.2 and 4.0 in the blind injection group . Three months after the injection , 15 ( 47 % ) patients in the blind group and 13 ( 41 % ) in the fluoroscopy group continued to have a positive outcome . Conclusion Although using fluoroscopic guidance dramatically increases treatment costs for greater trochanteric pain syndrome , it does not necessarily improve outcomes . Trial registration Clinical Output:

Minor adverse events reported included transient post-injection pain , facial redness and warmth . AUTHORS ' CONCLUSIONS Based upon moderate evidence from five trials , our review was unable to establish any advantage in terms of pain , function , shoulder range of motion or safety , of ultrasound-guided glucocorticoid injection for shoulder disorders over either l and mark-guided or intramuscular injection . The lack of any added benefit of ultrasound guided subacromial bursal injection over glucocorticoid injection administered into the upper gluteal muscles of the buttock suggests that the benefits of glucocorticoid may arise through systemic rather than local effects . Therefore , although ultrasound guidance may improve the accuracy of injection to the putative site of pathology in the shoulder , it is not clear that this improves its efficacy to justify the significant added cost

MS2_1shot462

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: We provide current , normative data on the prevalence of impotence , and its physiological and psychosocial correlates in a general population using results from the Massachusetts Male Aging Study . The Massachusetts Male Aging Study was a community based , r and om sample observational survey of noninstitutionalized men 40 to 70 years old conducted from 1987 to 1989 in cities and towns near Boston , Massachusetts . Blood sample s , physiological measures , socio-demographic variables , psychological indexes , and information on health status , medications , smoking and lifestyle were collected by trained interviewers in the subject 's home . A self-administered sexual activity question naire was used to characterize erectile potency . The combined prevalence of minimal , moderate and complete impotence was 52 % . The prevalence of complete impotence tripled from 5 to 15 % between subject ages 40 and 70 years . Subject age was the variable most strongly associated with impotence . After adjustment for age , a higher probability of impotence was directly correlated with heart disease , hypertension , diabetes , associated medications , and indexes of anger and depression , and inversely correlated with serum dehydroepi and rosterone , high density lipoprotein cholesterol and an index of dominant personality . Cigarette smoking was associated with a greater probability of complete impotence in men with heart disease and hypertension . We conclude that impotence is a major health concern in light of the high prevalence , is strongly associated with age , has multiple determinants , including some risk factors for vascular disease , and may be due partly to modifiable para-aging phenomena We investigated the effect of adding a psychoeducational intervention to oral sildenafil ( PsychoedPlusMed ) in the treatment of erectile dysfunction ( ED ) . Overall treatment satisfaction , as measured by the Erectile Dysfunction Inventory of Treatment Satisfaction ( EDITS ; Althof & Seftel , 1995 ) , was significantly higher in the PsychoedPlusMed patients than in the sildenafil-only patients at 12 weeks and at 24 weeks . PsychoedPlusMed participants reported higher satisfaction with treatment onset , treatment duration , and sexual confidence . PsychoePlusMed participants also reported an increase in communication about sex with their partner . A brief psychoeducational intervention can improve treatment satisfaction with sildenafil therapy for ED This study compared the effectiveness of two components , a ban on sexual intercourse and communication of sexual preferences , in the treatment of couples in which the male was experiencing erectile dysfunction . Sixteen couples were r and omly assigned to one of two treatment conditions . In one condition spouses were asked to refrain from intercourse and to make an effort to communicate sexual tastes and preferences during noncoital erotic interaction . Couples in the second condition were assigned only the communication portion of the therapeutic instructions given to the first group . The treatment consisted of written instructions concerning tasks to be carried out at home . Therapist contact was minimal . Following a 1-month baseline period of self-monitoring using a daily record-keeping form , couples underwent a 1-month treatment period and follow-up testing after another month . Male subjects also underwent an endocrinological examination to ascertain testosterone and related hormone levels prior to participating in the treatment . Both treatment groups reported significant improvement in several measures of erectile functioning , general sexual functioning , and marital adjustment . However , the ban on intercourse did not add to the effectiveness of encouraging sexual communication , indicating that the former component probably did not contribute to change . Two pretreatment measures , the Sexual Interaction Inventory and testosterone level , were found to predict treatment outcome with sufficient accuracy to permit selection of future patients who might benefit from this type of treatment format . The effectiveness of a treatment consisting of written instructions with minimal therapist contact for males with erectile dysfunction have important cost-benefit implication The treatment for psychogenic erectile dysfunction has been previously managed by non-medical methods consisting of counseling with a psychiatrist , psychologist or sex therapist . The success rate for treatment with counseling has not been uniformly successful . This paper compares the treatment of psychogenic erectile dysfunction using st and ard sex therapy and self-injection therapy using low-dose PGE1 . Fifty men with psychogenic impotence were divided into two groups : st and ard sex therapy for twelve weeks or treatment using low-dose ( 2.5–5.0 μg ) of PGE1 . The results showed that men treated with low-dose PGE1 had a 47 % improvement of obtaining an unaided erection compared to 58 % improvement rate with sex therapy . 69 % of patients in the PGE1 group were satisfied with their treatment compared to 75 % receiving sex therapy . The frequency of intercourse reported in patient diaries for the two groups was similar ( 20.5 per month for PGE1 vs 20.0 per month for sex therapy . The reported duration of erection by patients receiving PGE1 therapy was longer than that reported by those receiving sex therapy ( 35 min vs 10 min ) . The comparison of the cost of treatment of the two treatment groups reveals that the sex therapy is approximately 25 % more expensive than the PGE1 treatment . This pilot study demonstrates that the efficacy of PGE1 was numerically , though not statistically , less than sex therapy in the treatment of psychogenic impotence . The cost per positive outcome with PGE1 treatment is lower than that of sex therapy treatment making PGE1 more cost-effective Abstract In a prospect i ve investigation of the long-term outcome of 140 couples who had entered sex therapy 1–6 yrs earlier for a variety of sexual dysfunctions , successful follow-up , mostly by interview , was possible with at least one partner in 75 % of cases . While recurrence of sexual difficulties was common , coping strategies were identified which often helped overcome relapses . Improvements in couples ' general relationships result ing from treatment were usually sustained . Long-term outcome was excellent for vaginismus , good for erectile dysfunction , but often poor for premature ejaculation , and especially , for female impaired sexual interest . While the results of this study support the continued use of sex therapy for sexual dysfunction , they also emphasize the need for new therapeutic approaches for problems with poor outcome , especially female loss of sexual interest The effects of three group treatment formats on 20 men with secondary erectile dysfunction and their partners were contrasted . After a comprehensive medical and psychological screening , each couple was assigned to one of three treatment groups ( Communication Technique Training , Sexual Technique Training , Combination Treatment ) or to one of two control groups ( Attention-Placebo , No-Treatment ) . Couples in the three treatment groups and the attention-placebo group participated in their respective formats in twice-weekly sessions for a total of 20 hours . The no-treatment control group received sex education and treatment after a 5-week waiting list period . All three treatment groups fostered substantial gains so that between-format differences were not statistically significant . Subject variables which predicted success/experience ratio gains included age of the male partner , perceived level of relationship adjustment , and the male partner 's success/experience ratio prior to treatment . Eighty-one percent of the treated men reached the criterion of 80 % or greater success/experience ratio ( successful penetration and subsequent ejaculation ) at the 6-month follow-up . Good nocturnal tumescence prior to treatment was correlated with a better treatment outcome than poor tumescence We admistered the International Index of Erectile Function ( IIEF ; Rosen et al. , 1997 ) question naire to 30 patients with psychogenic erectile dysfunction ( ED ) at baseline , immediately after treatment , and 3 months after treatment . We r and omized patients into three groups : group I , who had weekly sessions of time-limited theme-based group psychotherapy for 6 months and 50 mg sildenafil citrate orally on dem and ; group II , who had an intake of 50 mg sildenafl citrate orally on dem and for 6 months only ; and group III , who had weekly sessions of time-limited theme-based group psychotherapy for 6 months . We analyzed data ( 15-item IIEF ) for each group at three times during the study and compared by the data using analysis of variance ( ANOVA ) , followed by the Bonferroni multiple comparison test . We used Cochran 's Q-test for analysis between baseline and posttreatment stages of patients with remission of symptoms ( EF equal to or higher than 26 points ) . Group III had a mean score higher than group II , with the difference being statistically significant ( immediately after treatment , p = 0.033 ; at 3 months after treatment , p = 0.049 ; p < 0.05 ) . All three therapeutic alternatives result ed in an improvement of erectile function domain score . However , significant differences from baseline were observed in groups I ( p = 0.0009 ) and III ( p = 0.0002 ) but not in group II ( p = 0.135 ) . The psychotherapy groups , I and III , had significantly higher scores compared with group II , in which patients were exclusively treated with sildenafil citrate . These findings suggest that time-limited theme-based group psychotherapy is an effective treatment for psychogenic ED This study utilized a control group design to evaluate the effectiveness of group treatment of erectile dysfunction in men without partners . Twentyone men with secondary erectile dysfunction were r and omly assigned to one of two men 's groups with different cotherapy teams or to a waiting-list control condition . Results indicated that while the two men 's groups did not differ on any clinical - outcome measures , each men 's group improved significantly more than the waiting-list clients on a variety of measures concerning sexual attitudes and behaviors related to erectile dysfunction . Furthermore , most of the treatment gains for men 's group participants were maintained at six-week and six-month follow-up evaluations . However , the men 's group and waiting-list participants did not differ significantly in the reported frequency of erection difficulties following treatment . In comparing the present findings with those of previous studies of men 's group treatment , it is hypothesized that the absence of significant change in the frequency of erection difficulties in the present study may have been attributable to the older age of our clients or to the relative lack of emphasis on dating-skills training in this treatment format . This study illustrates the importance of including some form of no-treatment control condition in the evaluation of new treatments for sexual dysfunction A cohort of 45 patients diagnosed with predominant psychogenic erectile disorder ( ED ) chose couples psychotherapy . We r and omized 25 couples to also receive a vacuum constriction device ( VCD ) , also known as a vacuum erectile device , at the second session ( group 1 ) , whereas 20 couples had psychotherapy without a VCD . Twentyone couples ( 84 % ) in group 1 reported some improvement after the initial psychotherapy and VCD sessions compared with 12 of the 20 couples ( 60 % ) who reported some improvement after couples psychotherapy in group 2 . We subsequently found that 3 of the 4 couples in group 1 reporting no improvement had not used the pump provided . Early combination treatment of couples psychotherapy and a physical treatment such as a VCD may lead to a greater beneficial response in men with ED than therapy alone . The delay of demonstrating the capacity and potential benefit from a physical intervention may have a marked effect on the initial and ongoing response to sex therapy Abstract Two studies on the treatment of male sexual dysfunction are reported . In Study I , 24 couples were placed on a 6-week waiting list and subsequently treated with systematic desensitization ( SD ) or an adaptation of the Masters and Johnson method ( sex therapy , ST ) . Sexual function , satisfaction with the relationship , self-esteem and social anxiety were evaluated at the start of the waiting period , before and after treatment and in a follow-up . Both SD and ST led to improvement of sexual functioning , but a significant difference between treatments could not be demonstrated . Neither SD nor ST improved satisfaction with the relationship . In Study II , 32 couples were assigned to ST or rational emotive therapy ( RET ) . Sixteen couples dropped out of treatment . As compared with males who completed treatment , males who dropped out functioned relatively well sexually . Other differences between drop-outs and treatment-completers could not be demonstrated . In couples completing therapy , both ST and RET led to improvement of sexual functioning . Satisfaction with the relationship improved only in couples treated with RET . Significant differences between ST and RET could not be demonstrated in a valid way This study examined the effects of a sex and aging workshop highlighting permission and limited information on the sexual knowledge , attitudes , behaviors , and satisfaction of a group of older heterosexual couples experiencing erectile dysfunction . The workshop focused on disseminating information about the physiological and psychological changes that occur in the sexual response during the aging process . Twenty couples participated in this study : 10 attended a workshop and 10 served as controls . The study utilized a r and omized control group pretest/posttest design . Workshop participants completed an evaluation form and were interviewed at the time of follow-up . Data analysis revealed that the workshop participants reported significant increases in knowledge levels and in sexual satisfaction . The workshop evaluations and follow-up interviews reinforced these quantitative results . This study lends support to educational intervention as an adjunct to treatment of erectile dysfunction in the elderly population Objective To compare the acceptance of and satisfaction with intracavernosal injection ( ICI ) therapy with and without sexological counselling in men with erectile dysfunction ( ED ) This study was a controlled evaluation of men 's group treatment of erectile dysfunction that emphasized communication and dating skills training for men without partners . Following a 6-week pretreatment waiting period , 11 men were seen for 10 sessions in two men 's groups led by different cotherapy teams . Several female guest therapists attended three sessions to help the men role-play a sequence of difficult social interactions . A series of communication/dating homework assignments was added to the weekly sensual/sexual assignments . The results indicated no improvement during the waiting control period , but significant improvement on measures of sexual attitudes and behaviors following treatment . There was a significant reduction in the frequency of erection difficulties before intercourse and a trend toward reduction of erection difficulties during intercourse . These improvements were maintained Output:

Treatment response appeared to vary between patient subgroups , although there was no significant difference in improvement in erectile function according to mean group age , type of relationship , and severity of ED . There was evidence that group psychotherapy may improve erectile function . Treatment response varied between patient subgroups , but focused sex-group therapy showed greater efficacy than control group ( no treatment ) . In a meta- analysis that compared group therapy plus sildenafil citrate versus sildenafil , men r and omised to receive group therapy plus sildenafil showed significant improvement of successful intercourse , and were less likely than those receiving only sildenafil to drop out . Group psychotherapy also significantly improved ED compared to sildenafil citrate alone . Regarding the effectiveness of psychosocial interventions for the treatment of ED compared to local injection , vacuum devices and other psychosocial techniques , no differences were found

MS2_1shot463

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND The safety and efficacy of specific immunotherapy for mold allergy are not known in children and adolescents . OBJECTIVE We evaluated the efficacy and safety of specific immunotherapy with a st and ardized allergen extract in a r and omized , double-blind , placebo-controlled , 3-year prospect i ve study of patients who were allergic to only Alternaria alternata . METHODS Fifty children and adolescents ( 25 girls ; 5 - 18 years of age ) with A alternata-induced seasonal allergic rhinoconjunctivitis and /or bronchial asthma were r and omly assigned to groups given treatment ( Novo-Helisen Depot , A alternata 100 % ) or placebo . The primary end point was the combined symptom medication score . Secondary end points included safety , quality of life , and sensitivity to allergen-specific nasal challenge . RESULTS Forty-five children completed the 3-year study . Although there was no significant change in year 1 , the combined symptom medication score decreased in years 2 and 3 of the study ( by 38.7 % and 63.5 % , respectively ; P < .001 for each ) . The reduction in symptoms was associated with a significant improvement in quality of life ( P < .05 ) and decrease in sensitivity after allergen-specific nasal challenge . Side effects were observed in 7 patients ; the most common ( edema at the site of injection ) occurred after 11 injections . CONCLUSIONS Allergen-specific immunotherapy with st and ardized A alternata extract reduces symptoms of asthma and rhinoconjunctivitis in children and adolescents without serious side effects In this prospect i ve controlled study , 39 children with Alternaria-induced asthma and /or rhinitis were followed-up over a 3-year period . Skin tests and RAST were positive to Alternaria tenuis only . All children were treated with specific Alternaria immunotherapy . The long-term results have shown that immunotherapy was successful in 80 % of the children given more than 80.000 PNU . By contrast , the outcome of 40 selected controls also followed during the same period who did not receive immunotherapy was almost exactly the opposite . In addition to demonstrating the clinical effectivity of specific Alternaria immunotherapy , the authors stress the relationship between successful results , highest tolerated doses , and larger cumulative dosage , which is irrespective of the duration of the therapy Little knowledge is available on molds either from the environmental or clinical points of view . The latter is mainly due to the lack , until recent times , of purified and st and ardized extracts . Injective immunotherapy , largely used for patients allergic to mites and pollens , is regarded with some concern for molds . On the other h and , mold-related allergic symptoms ( i.e.,from Alternaria tenuis ) have in Italy an incidence of about 5 percent , mainly in young patients . We have therefore run a pilot study comparing the efficacy and safety of injective ( SIT ) and sublingual ( SLIT ) immunotherapy by administering the same purified and st and ardized extract of Alternaria tenuis to a total of 23 patients for two years , according to an open experimental plan . Excellent tolerance was shown to SLIT while four ( two medium- grade ) side effects appeared with SIT . Clinical improvement , subjectively stated comparing symptoms ( mainly rhinitis ) and drug consumption before and after the therapy , confirmed by an increase in the Specific Nasal Provocation threshold , was obtained with both therapies , but with a statistically significant difference in favour of SLIT . Skin reactivity and blood Alternaria tenuis specific IgE , total IgG and IgG changed in the SIT-treated group , while no statistically significant change was shown in the SLIT-treated group . These results are in good agreement with previous reports on SIT and SLIT with other inhalant allergens ( mites , grasses ) , and suggest the potential use of SLIT for Alternaria allergy , mainly in young patients , when there are concerns about the safety of and compliance with the traditional injective therapy A placebo‐controlled , double‐blind study of immunotherapy with the mould species Cladosporium was performed in 22 adult asthmatics . The diagnosis of Cladosporium allergy was based on a combination of bronchial provocation test and daily symptom score in the Cladosporium season . An aqueous preparation of a potent , biologically st and ardized and purified extract was used in a clustered dose‐increase regimen . The clinical efficacy was evaluated by a combination of symptoms ( asthma score + peak flow ) and consumption of antiasthmatic medication . The mean changes in symptoms and medication consumption over a 10–week registration period ( peak Cladosporium season ) in 1982 after 5–7 months of immunotherapy were compared with the corresponding 1981 pretreatment 10‐week period A significant ( P= 0.03 ) difference in terms of “ improved ” , “ unchanged ” and “ deteriorated ” patients in favour of Cladosporium treatment was found . Approximately 80 % in the Cladosporium group showed improved/unchanged symptoms contrary to 30 % of the placebo treated . Side effects were observed frequently but only in the Cladosporium‐treated . About 70 % experienced a large local reaction and 100 % had episodes of asthma during dose‐increase phase . Only a few severe systemic reactions occurred . Based on the clinical efficacy of the treatment we consider immunotherapy with Cladosporium feasible for highly specialized clinics A double‐blind histamine placebo controlled immunotherapy trial was performed to investigate the clinical effect of a purified and st and ardized Cladosporium herbarum allergen preparation . Thirty children with a clinical history suggesting mould‐induced asthma and /or rhinoconjuctivitis were included . The diagnosis was confirmed by positive skin prick test and Phadebas RAST ® as well as positive bronchial and /or conjunctival provocation test to Cladosporium herbarum . Immunotherapy was given for 10 months in a double‐blind manner to r and omized groups with either Pharmalgen ® /Cladosporium herbarum preparation or histamine placebo . Allergic side effects to injections were common , especially during the peak of the mould season ( July‐September in Sc and inavia ) . In the active group , 13/16 patients experienced general reactions during the first 10 months of treatment . After 6 months of treatment , eye , nose and bronchial symptom scores and peak expiratory flow rates were similar for the groups , maybe because most of the children were also sensitive to many other allergens , including Alternaria alternala . However , medication scores were significantly lower in the treated group ( P < 0.01 ) . Bronchial ( P < 0.01 ) and conjunctival sensitivity ( P= 0.01 ) were significantly reduced in the Cladosporium‐treated group but not in the placebo group after 10 mouths of treatment . This is the first double‐blind clinical trial showing the clinical efficacy of immunotherapy in children with mould‐induced asthma Studies of immunotherapy with oral Alternaria extracts are scarce . We decided to perform a clinical trial of the clinical safety and efficacy of this extract as well as of its effects on in vivo and in vitro parameters in 39 patients with Alternaria allergy , aged between 7 and 17 years , who are also sensitized extract was used . Allergic activity was determined through RAST inhibition and skin prick test . Quantification of the principal allerten ( Alt a 1 ) was performed through the 2-site binding assay , with a mean content of 34.2 ng Alt a 1/micro g protein . The parameters analyzed were the symptom-medication score , skin prick using the end-point technique , specific bronchial challenge test , peak flow , total and specific IgE and IgG4 . Nineteen patiens received active treatment with oral immunotherapy and another 19 received symptomatic treatment . The initial phase of immunotherapy lasted 3 months until the maximum dose was reached . This was maintained for 12 months ; the mean accumulated dos was 280,000 PNU . Significant differences were found in reduction in the symptom-medication score in the treated group after 12 months of immunotherapy . No differences were found in the control group . Immunotherapy was well tolerated with 0.42 adverse reactions per 100 doses administered . All adverse reactions were mild-to-moderate . In the treated group , papule size was significantly reduced . Values for the specific bronchial challenge test , expressed through PD20 , were significantly higher in the immunotherapy group . Peak flow showed no changes in either group . Values of IgG4 were significantly higher in the immunotherapy group . Total and specific IgE levels showed no significant changes in either group . In conclusion , oral immunotherapy with Alternaria extract is clinical ly effective in pediatric patients . In general , the therapy was well tolerated . It modified specific cutaneous and bronchial reactivity in our sample and increased levels of specific IgG4 , wich are implicated in humoral response INTRODUCTION Sensitisation to Alternaria is a cause of respiratory disease in Spain , particularly in childhood , but it is also a significant marker of the severity of this disease . Therefore , the use of an aetiological treatment ( allergen specific immunotherapy ) is essential , and both subjective and objective clinical parameters should be used to follow up this treatment . OBJECTIVE This open-label , uncontrolled , observational , prospect i ve study was design ed in order to study the evolution of these patients on allergen specific immunotherapy therapy in daily clinical practice and to assess the use of different monitoring tools . MATERIAL AND METHODS A total of 99 patients were included . They were monosensitised to this perennial allergen and treated with subcutaneous allergen specific immunotherapy . After one year of follow-up , these patients were assessed for the presence of symptoms , use of medication , clinical incidents , quality of life and asthma control . RESULTS After one year of treatment a significant fall was observed in the use of concomitant medication ( β2-agonists : p=0.0278 , inhaled corticosteroids : p=0.0007 , anti-leukotrienes : p=0.0495 ) , nasal symptoms ( p=0.0081 ) , quality of life ( PAQLQ , p<0.0001 ) and asthma control ( ACQ , p<0.0001 ) . Twenty-one patients had to attend emergency department due to exacerbation of their allergic disease , and only one of them had to be admitted to hospital . CONCLUSION respiratory allergic disease due to Alternaria alternata is a disease which is hard to control , and in our daily practice , the use of specific subcutaneous immunotherapy can be of significant benefit in our paediatric patients Allergen-specific immunotherapy ( ASIT ) with fungal extracts has been beset by safety and efficacy problems , which result mainly from qualitative and quantitative variations . Little has been published on the safety and efficacy of these extracts . The objective was to analyze the safety and efficacy of ASIT with an Alternaria alternata extract . A total of 28 patients were selected with rhinitis and /or bronchial asthma because of Alternaria allergy and monosensitization to molds . The patients were r and omized to an active ASIT or placebo group , both groups on a conventional immunotherapy schedule ( increasing weekly doses until maintenance dose and then monthly doses ) . Adverse reactions were classified with the European Academy of Allergology and Clinical Immunology system . Clinical efficacy was analyzed for a year with symptom/medication diary cards , peak expiratory flow ( PEF ) measures , clinical severity score , severity of symptoms ( visual analog scale ) , subjective evaluation of treatment by the patient and the physician , and a quality of life question naire . Twenty-three patients completed the study ; all reached the established maintenance dose with only two mild adverse reactions in the whole sample . Significant improvements were found after 6 months in respiratory symptoms in the active treatment group , and in all symptoms in both groups . PEF increased significantly in the active treatment group but not in the placebo group . The severity of asthma decreased in the active treatment group , and the severity of rhinitis decreased in both groups . Visual analog scale scores for severity of symptoms improved in all phases in the active treatment group , but only after 12 months in the placebo group . Physicians judged the disease course as significantly better in the active treatment group . ASIT with the A. alternata extract was safe , with clinical improvements after one year of treatment BACKGROUND Respiratory allergy due to Alternaria is a relevant clinical problem , and specific immunotherapy may represent a viable treatment option . Sublingual immunotherapy ( SLIT ) is safe and effective , but data for Alternaria are lacking . OBJECTIVE To assess the efficacy of st and ardized SLIT in patients sensitized to Alternaria in a r and omized , prospect i ve , double-blind , placebo-controlled trial . METHODS Patients with rhinitis with or without intermittent asthma and ascertained allergy to Alternaria were enrolled . After a baseline season , SLIT or matched placebo was given for 10 months . Symptoms and rescue medication intake were recorded on diary cards between June and October . Skin prick testing was performed and specific IgE , IgG4 , and precipitin levels were measured at baseline and at the end of the study . RESULTS Twenty-seven patients ( age range , 14 - 42 years ) were r and omized , and 26 completed the study . The baseline characteristics were homogeneous in the 2 groups . After treatment , patients receiving SLIT had a significant improvement in symptoms and a reduction in medication intake vs placebo and vs the run-in season , whereas no change was seen in the placebo group . Skin prick test reactivity significantly decreased only in the SLIT group . No change was seen in specific IgG4 levels in the 2 groups , whereas Alt a 1 specific IgE levels significantly increased in the active group . One patient in the active group reported oral itching and conjunctivitis Output:

Low strength evidence suggests that mould AIT is efficacious for the treatment of respiratory allergies .

MS2_1shot464

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: OBJECTIVE To evaluate the effectiveness of a program to increase walking to and from school . DESIGN A cluster r and omised controlled trial . SETTING 24 primary public schools in inner west Sydney , Australia . PARTICIPANTS 1996 students aged 10 - 12 years and their parents . INTERVENTION A two-year multi-component program included classroom activities , development of school Travel Access Guides , parent newsletters and improving environments with local councils . MEASURES Two measures were used : a survey completed by students on how they travelled to and from school over five days , and a survey completed by their parents on how their child travelled to and from school in a usual week . RESULTS The percentage of students who walked to and from school increased in both the intervention and control schools . Data from parent surveys found that 28.8 % of students in the intervention group increased their walking , compared with 19 % in the control group ( a net increase of 9.8 % , p=0.05 ) . However this effect was not evident in the student data . CONCLUSION The study produced a mixed result , with a high variation in travel patterns from school to school . Intervention research should address the complexity of multiple factors influencing student travel to school with a focus on changing local environments and parents ' travel to work BACKGROUND The purpose of this study was to determine the effectiveness of Ready for Recess : an elementary school recess intervention targeting staff training ( ST ) and providing recreational equipment ( EQ ) . METHODS Ready for Recess had 4 intervention schools : 1 ) EQ+ST , 2 ) EQ , 3 ) ST , and 4 ) control . Moderate-to-vigorous physical activity ( MVPA ) was assessed with accelerometers at the four schools in 257 3rd- to 6th- grade children . R and om intercept models for overweight/obese ( OWOB ) and healthy weight ( HW ) for boys and girls separately , examined change in percentage of time spent in MVPA during recess across EQ+ST , EQ , and ST compared with the control from baseline to postintervention . RESULTS HW boys receiving EQ+ST increased MVPA by 19.4 % , OWOB boys receiving ST increased MVPA by 4.5 % , OWOB girls receiving EQ-ST increased MVPA by 6.0 % , while HW girls receiving EQ decreased MVPA by 13.6 % in comparison with the control . CONCLUSIONS Ready for Recess represents a possible means to increase MVPA in OWOB girls/boys , population s least likely to meet MVPA recommendations . However , the effect of the intervention was not uniform across all subgroups Background To evaluate the impact of a walking school bus ( WSB ) program on student transport in a low-income , urban neighborhood . Methods The design was a controlled , quasi-experimental trial with consecutive cross-sectional assessment s. The setting was three urban , socioeconomically disadvantaged , public elementary schools ( 1 intervention vs. 2 controls ) in Seattle , Washington , USA . Participants were ethnically diverse students in kindergarten-5th grade ( aged 5–11 years ) . The intervention was a WSB program consisting of a part-time WSB coordinator and parent volunteers . Students ' method of transportation to school was assessed by a classroom survey at baseline and one-year follow-up . The Pearson Chi-squared test compared students transported to school at the intervention versus control schools at each time point . Due to multiple testing , we calculated adjusted p-values using the Ryan-Holm stepdown Bonferroni procedure . McNemar 's test was used to examine the change from baseline to 12-month follow-up for walking versus all other forms of school transport at the intervention or control schools . Results At baseline , the proportions of students ( n = 653 ) walking to the intervention ( 20 % + /- 2 % ) or control schools ( 15 % + /- 2 % ) did not differ ( p = 0.39 ) . At 12-month follow up , higher proportions of students ( n = 643 , p = 0.001 ) ) walked to the intervention ( 25 % + /- 2 % ) versus the control schools ( 7 % + /- 1 % ) . No significant changes were noted in the proportion of students riding in a car or taking the school bus at baseline or 12-month follow up ( all p > 0.05 ) . Comparing baseline to 12-month follow up , the numbers of students who walked to the intervention school increased while the numbers of students who used the other forms of transport did not change ( p < 0.0001 ) . In contrast , the numbers of students who walked to the control schools decreased while the numbers of students who used the other forms of transport did not change ( p < 0.0001 ) . Conclusion A WSB program is a promising intervention among urban , low-income elementary school students that may promote favorable changes toward active transport to school . Trial Registration Clinical Trials.gov Background This paper reports the primary outcomes of the Healthy Opportunities for Physical Activity and Nutrition ( HOP'N ) after-school project , which was an effectiveness trial design ed to evaluate the prevention of childhood obesity through building the capacity of after-school staff to increase physical activity ( PA ) and fruit and vegetable ( FV ) opportunities . Methods We conducted a three-year , nested cross-sectional group r and omized controlled effectiveness trial . After a baseline assessment year ( 2005 - 2006 ) , schools and their after-school programs were r and omized to the HOP'N after-school program ( n = 4 ) or control ( n = 3 ) , and assessed for two subsequent years ( intervention year 1 , 2006 - 2007 ; intervention year 2 , 2007 - 2008 ) . Across the three years , 715 fourth grade students , and 246 third and fourth grade after-school program participants were included in the study . HOP'N included community government human service agency ( Cooperative Extension ) led community development efforts , a three-time yearly training of after-school staff , daily PA for 30 minutes following CATCH guidelines , a daily healthful snack , and a weekly nutrition and PA curriculum ( HOP'N Club ) . Child outcomes included change in age- and gender-specific body mass index z-scores ( BMI z ) across the school year and PA during after-school time measured by accelerometers . The success of HOP'N in changing after-school program opportunities was evaluated by observations over the school year of after-school program physical activity sessions and snack FV offerings . Data were analyzed in 2009 . Results The intervention had no impact on changes in BMI z. Overweight/obese children attending HOP'N after-school programs performed 5.92 minutes more moderate-to-vigorous PA per day after intervention , which eliminated a baseline year deficit of 9.65 minutes per day ( p < 0.05 ) compared to control site overweight/obese children . Active recreation program time at HOP'N sites was 23.40 minutes ( intervention year 1 , p = 0.01 ) and 14.20 minutes ( intervention year 2 , p = 0.10 ) greater than control sites . HOP'N sites and control sites did not differ in the number of FV offered as snacks . Conclusions The HOP'N program had a positive impact on overweight/obese children 's PA and after-school active recreation time . Trial registration NCT01015599 Background : An increased prevalence of overweight/obesity among children has led to school district level policies to increase physical activity ( PA ) among elementary school students . Interventions are needed that increase activity levels without sacrificing time spent in academics . Objectives : We evaluated a policy implementation intervention for to increase in-school PA in elementary schools in Forsyth County , North Carolina , in a r and omized study with a delayed intervention control group . Methods : The study included third- through fifth- grade classrooms in eight elementary schools . Instant Recess ® was used to introduce 10-minute PA breaks in classrooms on schedules determined by teachers . Direct observation was used to measure activity levels , other student behaviors , and teacher behaviors related to PA in the classrooms . Results : Twenty-eight visits to schools were made during the spring and fall semesters of 2009 . At baseline 11 % to 44 % of intervention and control schools were engaged in classroom-based PA . PA increased from baseline to spring follow-up in intervention schools and was maintained the following fall . Control schools decreased PA from baseline to spring and increased PA once they began the intervention . Students in classrooms engaged in Instant Recess exhibited statistically significant increases in light ( 51 % ) and moderate-intensity ( 16 % ) PA and increases in time spent in on-task behavior ( 11 % ) . Control schools experienced similar benefits after they began implementing Instant Recess . Conclusions : Instant Recess is useful for increasing PA and improving behavior among elementary school children . Additional research may be needed to underst and how to create policies supporting classroom activity breaks and how to assess policy adherence BACKGROUND Physical Activity Across the Curriculum ( PAAC ) was a three-year cluster r and omized controlled trial to promote physical activity and diminish increases in overweight and obesity in elementary school children . METHODS Twenty-four elementary schools were cluster r and omized to the Physical Activity Across the Curriculum intervention or served as control . All children in grade s two and three were followed to grade s four and five . Physical Activity Across the Curriculum promoted 90 min/wk of moderate to vigorous intensity physically active academic lessons delivered by classroom teachers . Body Mass Index was the primary outcome , daily Physical activity and academic achievement were secondary outcomes . RESULTS The three-year change in Body Mass Index for Physical Activity Across the Curriculum was 2.0+/-1.9 and control 1.9+/-1.9 , respectively ( NS ) . However , change in Body Mass Index from baseline to 3 years was significantly influenced by exposure to Physical Activity Across the Curriculum . Schools with > or = 75 min of Physical Activity Across the Curriculum/wk showed significantly less increase in Body Mass Index at 3 years compared to schools that had < 75 min of Physical Activity Across the Curriculum ( 1.8+/-1.8 vs. 2.4+/-2.0 , p=0.02 ) . Physical Activity Across the Curriculum schools had significantly greater changes in daily Physical activity and academic achievement scores . CONCLUSIONS The Physical Activity Across the Curriculum approach may promote daily Physical activity and academic achievement in elementary school children . Additionally , 75 min of Physical Activity Across the Curriculum activities may attenuate increases in Body Mass Index BACKGROUND Less than half of elementary children meet the physical activity recommendations of 30 to 60 minutes of moderate-to-vigorous physical activity ( MVPA ) on a daily basis . Recess provides the single biggest opportunity for children to accumulate MVPA . This study explored whether a teacher 's social prompting to be active during recess alone and modeling of active recess-time games alone may increase the amount of MVPA children accumulate during recess . METHODS Three demographically matched schools were r and omly assigned to receive a social prompting intervention , modeling intervention , or to serve as a comparison group . Pre- and postintervention physical activity data was collected utilizing accelerometers . RESULTS Compared with preintervention , MVPA during recess increased significantly in the social prompting group and decreased significantly in the modeling group . There were no significant changes in the comparison group . There was a significant interaction between time and intervention : pre- to postintervention change between interventions was significant for modeling versus comparison and modeling versus social prompting , but not for social prompting versus comparison . CONCLUSIONS Modeling was not an effective strategy for increasing MVPA during recess . Social prompting may be an effective strategy for increasing MVPA during recess . However , larger studies are needed to determine whether social prompting increases MVPA during recess . In light of evidence suggesting that MVPA is linked to lower obesity rates , and a substantial number of health and academic benefits , social prompting may be a useful strategy to further explore to address the childhood obesity epidemic , and improve students ' health and academic outcomes The primary responsibility for engaging children in opportunities to be physically active and learn physical skills rests with school physical education . This study evaluated the effects of a combined health-related curriculum and inservice program on the quantity and quality of elementary school physical education lessons . Seven schools ( N = 28 fourth- grade classes ) in one district were r and omly assigned to one of three conditions : 10 classes were taught in their usual manner by classroom teachers ( Control [ CO ] ) ; 10 classes were taught by trained classroom teachers ( TT ) who received inservice training and follow-up consultations ; and 8 classes were taught by physical education specialists ( PES ) hired by the research project . Student activity level , curriculum context , and teacher behavior were directly observed and coded during a sample of 112 lessons over an 8-month period . Results indicated significant differences in both the frequency and mean length of classes ( PES , 26.7 min ; TT , 23.4 min ; CO , 18.9 min ) . Additionally , the curriculum and inservice program equipped trained classroom teachers to provide significantly better classes than were provided by controls in terms of student activity engagement , lesson context , and active instructional behavior , though their classes did not match the quality of those taught by the physical education specialists . This study is unique in its use of direct observation of lessons to assess a curriculum and inservice intervention IMPORTANCE Identifying community-based programs that increase physical activity among diverse youth could yield sustainable tools to reduce obesity and obesity disparities . OBJECTIVE To evaluate the impact of a community-based after-school soccer and youth development program , America SCORES , on students ' physical activity , weight status , and fitness . DESIGN Cluster-r and omized trial . Study measures were collected in the fall ( baseline ) , winter ( midpoint ) , and spring ( end point ) of the 2009 - 2010 school year . SETTING After-school programs in 6 schools within a large urban school district . PARTICIP Output:

These findings indicate that interventions in active travel and classrooms setting s positively influence youth PA .

MS2_1shot465

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Purpose : To determine the primary success and short-term patency of stent application as a primary treatment modality for high- grade lesions of the infrapopliteal arteries compared with treatment with percutaneous transluminal angioplasty ( PTA ) in critical limb ischemia in a r and omized prospect i ve study . Methods : Endovascular therapy was performed on 95 lesions in 51 patients ( mean age 72.0 years , range 47–80 years ) who presented clinical ly with Fontaine stages III and IV . One patient underwent treatment in both limbs . After angiographic lesion identification , patients were r and omized for treatment by PTA ( 53 lesions in 27 patients ) or stent application ( 42 lesions in 24 patients ) . Follow-up by clinical investigation and conventional angiography or spiral CT angiography was performed in 37 patients ( 57 lesions ) 6 to 12 months after the procedure , or when clinical ly indicated . Evaluation was performed by two observers , double-blinded , with thresholds for lesion restenosis of 50 % and 70 % . Statistical evaluation was performed on a lesion basis by Kaplan – Meier estimated probability rates , and log-rank and Wilcoxon tests . The primary endpoint was the angiographic patency rate of treated lesions . Results : The inter-reader agreement was high ( κ = 0.82 ) . For the stent group the cumulative primary patency at 6 months was 83.7 % at the 70 % restenosis threshold , and 79.7 % at the 50 % restenosis threshold . For PTA , the primary patency at 6 months was 61.1 % at the 70 % restenosis threshold and 45.6 % at the 50 % restenosis threshold . Both results were statistically significant ( p < 0.05 ) . Conclusion : Infrapopliteal stent application is an effective treatment modality for high- grade lesions in chronic critical limb ischemia . Compared with PTA , higher patency rates can be expected after 6 months Background —Endovascular infrapopliteal treatment of patients with critical limb ischemia using percutaneous transluminal angioplasty ( PTA ) and bail-out bare metal stenting ( BMS ) is hampered by restenosis . In interventional cardiology , drug-eluting stents ( DES ) have shown better patency rates and are st and ard practice nowadays . An investigator-initiated , multicenter , r and omized trial was conducted to assess whether DES also improve patency and clinical outcome of infrapopliteal lesions . Methods and Results —Adults with critical limb ischemia ( Rutherford category ≥4 ) and infrapopliteal lesions were r and omized to receive PTA±BMS or DES with paclitaxel . Primary end point was 6-month primary binary patency of treated lesions , defined as ⩽50 % stenosis on computed tomographic angiography . Stenosis > 50 % , retreatment , major amputation , and critical limb ischemia – related death were regarded as treatment failure . Severity of failure was assessed with an ordinal score , ranging from vessel stenosis through occlusion to the clinical failures . Seventy-four limbs ( 73 patients ) were treated with DES and 66 limbs ( 64 patients ) received PTA±BMS . Six-month patency rates were 48.0 % for DES and 35.1 % for PTA±BMS ( P=0.096 ) in the modified-intention-to-treat and 51.9 % and 35.1 % ( P=0.037 ) in the per- protocol analysis . The ordinal score showed significantly worse treatment failure for PTA±BMS versus DES ( P=0.041 ) . The observed major amputation rate remained lower in the DES group until 2 years post-treatment , with a trend toward significance ( P=0.066 ) . Less minor amputations occurred after DES until 6 months post-treatment ( P=0.03 ) . Conclusions —In patients with critical limb ischemia caused by infrapopliteal lesions , DES provide better 6-month patency rates and less amputations after 6 and 12 months compared with PTA±BMS . Clinical Trial Registration —URL : http://www . clinical trials.gov . Unique identifier : NCT00471289 The study was design ed as a feasibility trial to evaluate the use of GP IIb/IIIa blockade in connection with drug eluting stents , bare stents and PTA only . Sixty patients with current ulcers were r and omly assigned to receive abciximab plus a sirolimus coated stent ( N.=14 ) , abciximab plus a bare stent ( N.=16 ) , abciximab plus PTA ( N.=14 ) and PTA alone ( N.=19 ) . Angiographic control was performed at two and six months . Recanalization was successful in all cases . Two month restenosis rate was 9 % , 45.5 % , 67 % and 46 % . At six month follow-up restenosis rate was 9 % , 67 % , 75 % and 58 % , respectively ; 14 % of all patients had major amputations within six months . Adjunctive administration of abciximab during peripheral arterial intervention below the knee was found to be safe . Sirolimus coated stent administration was followed by a higher patency rate BACKGROUND The Bypass versus Angioplasty in Severe Ischaemia of the Leg ( BASIL ) trial showed in patients with severe lower limb ischemia ( rest pain , tissue loss ) who survive for 2 years after intervention that initial r and omization to bypass surgery , compared with balloon angioplasty , was associated with an improvement in subsequent amputation-free survival and overall survival of about 6 and 7 months , respectively . The aim of this report is to describe the angiographic severity and extent of infrainguinal arterial disease in the BASIL trial cohort so that the trial outcomes can be appropriately generalized to other patient cohorts with similar anatomic ( angiographic ) patterns of disease . METHODS Preintervention angiograms were scored using the Bollinger method and the TransAtlantic Inter-Society Consensus ( TASC ) II classification system by three consultant interventional radiologists and two consultant vascular surgeons unaware of the treatment received or patient outcomes . RESULTS As was to be expected from the r and omization process , patients in the two trial arms were well matched in terms of angiographic severity and extent of disease as documented by Bollinger and TASC II . In patients with the least overall disease , it tended to be concentrated in the superficial femoral and popliteal arteries , which were the commonest sites of disease overall . The below knee arteries became increasingly involved as the overall severity of disease increased , but the disease in the above knee arteries did not tend to worsen . The posterior tibial artery was the most diseased crural artery , whereas the peroneal appeared relatively spared . There was less interobserver disagreement with the Bollinger method than with the TASC II classification system , which also appears inherently less sensitive to clinical ly important differences in infrapopliteal disease among patients with severe leg ischemia . CONCLUSIONS Anatomic ( angiographic ) disease description in patients with severe leg ischemia requires a reproducible scoring system that is sensitive to differences in crural artery disease . The Bollinger system appears well suited for this purpose , but the TASC II classification system less so . We hope this detailed analysis will facilitate appropriate generalization of the BASIL trial data to other groups of patients affected by similar anatomic ( angiographic ) patterns of disease OBJECTIVES The study investigated the efficacy and safety of a balloon exp and able , sirolimus-eluting stent ( SES ) in patients with symptomatic infrapopliteal arterial disease . BACKGROUND Results of infrapopliteal interventions using balloon angioplasty and /or bare stents are limited by a relatively high restenosis rate , which could be potentially improved by stabilizing the lesion with a SES . METHODS Two hundred patients ( total lesion length 27 ± 21 mm ) were r and omized to infrapopliteal SES stenting or percutaneous transluminal balloon angioplasty ( PTA ) . The primary endpoint was 1-year in-segment binary restenosis by quantitative angiography . RESULTS Ninety-nine and 101 patients ( mean age 73.4 years ; 64 % diabetics ) were r and omized to SES and PTA , respectively ( 8 crossover bailout cases to SES ) . At 1 year , there were lower angiographic restenosis rates ( 22.4 % vs. 41.9 % , p = 0.019 ) , greater vessel patency ( 75.0 % vs. 57.1 % , p = 0.025 ) , and similar death , repeat revascularization , index-limb amputation rates , and proportions of patients with improved Rutherford class for SES versus PTA . CONCLUSIONS SES implantation may offer a promising therapeutic alternative to PTA for treatment of infrapopliteal peripheral arterial disease Purpose : To report the 1-year angiographic and clinical outcome from a prospect i ve single-center study investigating the infrapopliteal application of sirolimus-eluting versus bare metal stents in patients with critical limb ischemia ( CLI ) who underwent below-the-knee endovascular revascularization . Methods : Stenting was performed as a bailout procedure for suboptimal angioplasty results ( flow-limiting dissection , elastic recoil , or postangioplasty residual stenosis > 30 % ) . In the first 29 patients , infrapopliteal stenting was performed with bare metal stents ( group B ) and with sirolimus-eluting stents in the other 29 patients ( group S ) . Results : Below-the-knee angioplasty and stenting involved 65 lesions in 40 infrapopliteal arteries of 29 limbs in group B and 66 lesions in 41 infrapopliteal arteries of 29 limbs in group S. Baseline comorbidities ( hyperlipidemia and symptomatic cardiac and carotid disease ) were more pronounced in group S ( p<0.05 ) . At 6 months , sirolimus-eluting stents demonstrated significantly higher primary patency ( OR 5.625 , 95 % CI 1.711 to 18.493 , p=0.004 ) and decreased in-stent binary restenosis ( OR 0.067 , 95 % CI 0.021 to 0.017 , p<0.001 ) and in-segment binary restenosis ( OR 0.229 , 95 % CI 0.099 to 0.533 , p=0.001 ) . After 1 year , sirolimus-eluting stents were steadily associated with increased primary patency ( OR 10.401 , 95 % CI 3.425 to 31.589 , p<0.001 ) and significantly less in-stent ( OR 0.156 , 95 % CI 0.060 to 0.407 , p<0.001 ) and in-segment ( OR 0.089 , 95 % CI 0.023 to 0.349 , p=0.001 ) binary restenosis . In addition , sirolimus-eluting stents were associated with significantly fewer cumulative target lesion re interventions at 6 months ( OR 0.057 , 95 % CI 0.008 to 0.426 , p=0.005 ) and 1 year ( OR 0.238 , 95 % CI 0.067 to 0.841 , p=0.026 ) . No significant differences between groups B and S were noted at 1 year with respect to mortality ( 10.3 % versus 13.8 % , respectively ) , minor amputation ( 17.2 % versus 10.3 % ) , or limb salvage ( 100 % versus 96 % ) . Conclusion : The application of sirolimus-eluting stents reduces the restenosis rate in the infrapopliteal arteries and the rate of repeat endovascular procedures the first year after treatment Excellent results with small stents in coronary arteries have led endovascular therapists to their use in infrapopliteal vessels . However , to date no level I evidence exists to recommend primary stenting over infrapopliteal angioplasty alone . The aim of this r and omized single-center trial was to compare their 1-year outcome . A total of 38 limbs in 35 patients with critical limb ischemia were r and omized to angioplasty ( 22 pts ) or primary stenting ( 16 pts ) . Target lesions were infrapopliteal occluded ( 36 ) or stenotic ( 20 ) lesions ranging from < 2 to > 15 cm in length . The mean age was 72 years . At 12 months , there was no statistical difference in survival ( angioplasty , 69.3 % ; primary stenting , 74.7 % ) , in limb salvage ( angioplasty , 90 % ; primary stenting , 91.7 % ) , or in primary and secondary patency ( angioplasty , 66 and 79.5 % ; primary stenting , 56 and 64 % ) between the groups Renal insufficiency was the only significant negative predicting factor for limb salvage in both groups . In conclusion , the 1-year results for both groups were broadly similar . Stenting has its place in infrapopliteal angioplasty if the procedure is jeopardized by a Output:

Trials show that the immediate technical success rate of restoring luminal patency is higher in the stent group but reveal no clear differences in short-term patency at six months between infrapopliteal arterial lesions treated with PTA with stenting versus those treated with PTA without stenting . We ascertained no clear differences between groups in periprocedural complications , major amputation , and mortality . However , use of different regimens for pretreatment and post-treatment antiplatelet/anticoagulant medication and the duration of its use within and between trials may have influenced the outcomes .

MS2_1shot466

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: The aim of this study was to assess effects of a short-term resistance program on strength in fit young women using weight machines/free weights or elastic tubing . 42 physically fit women ( 21.79±0.7 years ) were r and omly assigned to the following groups : ( i ) the Thera-B and ( ® ) Exercise Station Group ( TBG ) ; ( ii ) the weight machines/free weights group ( MFWG ) ; or ( iii ) the control group ( CG ) . Each experimental group performed the same periodised training program that lasted for 8 weeks , with 2 - 4 sessions per week and 3 - 4 sets of 8 - 15 submaximal reps . A load cell ( Isocontrol ; ATEmicro , Madrid , Spain ) was used to test the evolution of the Maximum Isometric Voluntary Contraction ( MIVC ) in 3 different exercises : Vertical Rowing ( VR ) , Squat ( S ) and Back Extension ( BE ) . A mixed model MANOVA [ group ( CG , TBG , MFWG ) x testing time ( pre-test , post-test ) ] was applied to determine the effect of the different resistance training devices on strength . The only groups to improve their MIVC ( p<0.005 ) were TBG and MFWG , respectively : VR 19.87 % and 19.76 % ; S 14.07 and 28.88 ; BE 14.41 % and 14.00 % . These results indicate that resistance training using elastic tubing or weight machines/free weights have equivalent improvements in isometric force in short-term programs applied in fit young women Objective : To investigate the effects of elastic tubing training compared with conventional resistance training on the improvement of functional exercise capacity , muscle strength , fat-free mass , and systemic inflammation in patients with chronic obstructive pulmonary disease . Design : A prospect i ve , r and omized , eight-week clinical trial . Setting : The study was conducted in a university-based , outpatient , physical therapy clinic . Subjects : A total of 49 patients with moderate chronic obstructive pulmonary disease . Interventions : Participants were r and omly assigned to perform elastic tubing training or conventional resistance training three times per week for eight weeks . Main measures : The primary outcome measure was functional exercise capacity . The secondary outcome measures were peripheral muscle strength , health-related quality of life assessed by the Chronic Respiratory Disease Question naire ( CRDQ ) , fat-free mass , and cytokine profile . Results : After eight weeks , the mean distance covered during six minutes increased by 73 meters ( ±69 ) in the elastic tubing group and by 42 meters ( ±59 ) in the conventional group ( p < 0.05 ) . The muscle strength and quality of life improved in both groups ( P < 0.05 ) , with no significant differences between the groups . There was a trend toward an improved fat-free mass in both groups ( P = 0.05 ) . After the first and last sessions , there was an increase in interleukin 1β ( IL-1β ) and interleukin 10 ( IL-10 ) in both groups , while tumour necrosis factor alpha ( TNF-α ) was stimulated only in the conventional training group . Conclusion : Elastic tubing training had a greater effect on functional exercise capacity than conventional resistance training . Both interventions were equally effective in improving muscle strength and quality of life Ghigiarelli , JJ , Nagle , EF , Gross , FL , Robertson , RJ , Irrgang , JJ , and Myslinski , T. The effects of a 7-wk heavy elastic b and and weight chain program on upper body strength and upper body power in a sample of Division 1-AA football players . J Strength Cond Res 23(3 ) : 756 - 764 , 2009-The purpose of this study was to explore the effects of a 7-week heavy elastic b and and weighted-chain program on maximum muscular strength and maximum power in the bench press exercise . Thirty-six ( n = 36 ) healthy men aged 18 - 30 years old , from the Robert Morris University football team , volunteered to participate in this study . During the first week , predicted 1 repetition maximum ( 1RM ) bench press and a 5RM speed bench press tests were conducted . Subjects were r and omly divided into 3 groups ( n = 12 ) : elastic b and ( EB ) , weighted chain ( WC ) , and traditional bench ( C ) . During weeks 2 - 8 of the study , subjects were required to follow the prescribed resistance training program . Mean and SD of the predicted 1RM bench press and 5RM speed bench press were computed . A two-factor ( method X time ) analysis was applied to identify significant differences between the training groups . Significance was set at α = 0.05 . Results indicated a significant time ( p < 0.05 ) but no group effect for both predicted 1RM ( kg ) and 5RM peak power tests ( watts ) . Although not significant , results did show greater nonsignificant improvements in the EB ( 848 - 883 W ) and WC groups ( 856 - 878 W ) vs. control ( 918 - 928 W ) when the 2 highest and greatest values were selected regarding peak power . The use of EB and WC in conjunction with a general offseason strength and conditioning program can increase overall maximum upper-body strength in a sample of Division 1-AA football players . These types of training modalities add a unique training style and more flexibility with respect to exercise prescription for athletes and strength practitioners The power output generated with different barbell loads and which resistance generated the maximum mechanical power output ( Pmax ) during explosive bench press-type throws ( BT ) in a smith machine device were investigated in power-trained athletes . Thirty-one rugby league players were tested for 1 repetition maximum ( 1RM ) free-weight bench press strength ( 1RM BP ) . Maximal power output was assessed by the Plyometric Power System during BT using resistances of 40 , 50 , 60 , 70 , and 80 kg ( BT P40 , BT P50 , BT P60 , BT P70 , and BT P80 ) . It was found that BT Pmax occurred with resistance of 70.1 ± 7.9 kg , representing 55 ± 5.3 % of 1RM BP of 129.7 ± 14.3 kg . The power output with all loads except the BT P70 were different from the BT Pmax . The BT P70 and BT P80 were not different from each other . Furthermore , the BT P60 and BT P80 were not different from each other . This suggests that although resistances of 55 % 1RM BP may maximize power output during explosive BT , loads in the range of 46–62 % also allow for high power outputs . Resistances of 31–45 % of 1RM BP result ed in significantly lower power outputs . Compared with previous research of BT in strength-trained athletes , the results of this investigation suggest that power-trained athletes may generate their Pmax at higher percentages of 1RM Colado , JC and Triplett , NT . Effects of a short-term resistance program using elastic b and s versus weight machines for sedentary middle-aged women . J Strength Cond Res 22(5 ) : 1441 - 1448 , 2008-This study was design ed to determine whether different effects on functional capacity and body composition were produced by using different devices ( elastic b and s ( EBs ) versus weight machines ( WMs ) ) with the same resistance training program . Forty-five healthy sedentary middle-aged women volunteers were chosen and r and omly assigned to 1 of 3 groups : 21 subjects trained using EBs ( EBG ) , 14 in trained using WMs ( WMG ) , and 10 were controls ( CG ) . Both exercise groups trained with a periodized muscular endurance program twice a week for 10 weeks , with a total of 6 exercises per session for the major muscle groups . Exercise intensity was equalized by jointly monitoring the same targeted number of repetitions ( TNRs ) and rate of perceived exertion in active muscles ( RPE-AM ) . Functional capacity was assessed by using knee push-up ( KPU ) and 60-second squat ( S ) tests . Body composition was measured using an 8-polar bioelectrical impedance analyzer . The results for both the EBG and WMG show a decrease in fat mass ( p = 0.05 and p < 0.01 , respectively ) and an increase in both the fat-free mass ( p < 0.05 and p < 0.01 , respectively ) and the number of repetitions in the KPU ( p < 0.05 and p < 0.01 , respectively ) and S tests ( p < 0.01 in both ) . None of the variables measured for the CG varied significantly . It can be concluded that , independently of the device used , the combined monitoring of TNRs and RPE-AM can be a valid tool for controlling the resistance exercise intensity and can lead to healthy adaptations . EBs can thus offer significant physiological benefits that are comparable to those obtained from WMs in the early phase of strength training of sedentary middle-aged women Background High-intensity resistance training plays an essential role in the prevention and rehabilitation of musculoskeletal injuries and disorders . Although resistance exercises with heavy weights yield high levels of muscle activation , the efficacy of more user-friendly forms of exercise needs to be examined . Objective The aim of this study was to investigate muscle activation and perceived loading during upper-extremity resistance exercises with dumbbells compared with elastic tubing . Design A single-group , repeated- measures study design was used . Setting Exercise evaluation was conducted in a laboratory setting . Participants Sixteen female workers ( aged 26–55 years ) without serious musculoskeletal diseases and with a mean neck and shoulder pain intensity of 7.8 on a 100-mm visual analog scale participated in the study . Measurements Electromyographic ( EMG ) activity was measured in 5 selected muscles during the exercises of lateral raise , wrist extension , and shoulder external rotation during grade d loadings with dumbbells ( 2–7.5 kg ) and elastic tubing ( Thera-B and , red to silver resistance ) . The order of exercises and loadings was r and omized for each individual . Electromyographic amplitude was normalized to the absolute maximum EMG amplitude obtained during maximal voluntary isometric contraction and exercise testing . Immediately after each set of exercise , the Borg CR10 scale was used to rate perceived loading during the exercise . Results Resistance exercise with dumbbells as well as elastic tubing showed increasing EMG amplitude and perceived loading with increasing resistance . At the individually maximal level of resistance for each exercise — defined as the 3 repetitions maximum — normalized EMG activity of the prime muscles was not significantly different between dumbbells ( 59%–87 % ) and elastic tubing ( 64%–86 % ) . Perceived loading was moderately to very strongly related to normalized EMG activity ( r=.59–.92 ) . Limitations The results of this study apply only for exercises performed in a controlled manner ( ie , without sudden jerks or high acceleration ) . Conclusions Comparably high levels of muscle activation were obtained during resistance exercises with dumbbells and elastic tubing , indicating that therapists can choose either type in clinical practice . The Borg CR10 can be a useful aid in estimating intensity of individual rehabilitation protocol OBJECTIVE The aim of this study was to evaluate the efficacy and feasibility of two school-based RT programs to improve muscular fitness and body composition in adolescents . METHODS The study was conducted in Australia from July 2008 to June 2009 . Participants [ n=108 , mean age (SD)=15.0 ( 0.7 ) years ] were r and omized to free weights ( n=37 ) or elastic tubing ( n=41 ) RT groups and a control group was recruited ( n=30 ) . Participants in the RT groups completed 2 sets of 10 - 12 repetitions on 10 exercises for 8 weeks . Waist circumference , body composition ( bioelectrical impedance analysis ) and muscular strength ( bench press and leg press ) were assessed at baseline and posttest . RESULTS Boys ( p<0.001 ) and girls ( p<0.01 ) in both RT groups improved their body composition over the study period . Boys in both RT groups significantly improved both upper and lower body strength and their improvements were significantly greater than changes observed in the control group . Girls in the free weights groups achieved larger improvements in lower body strength compared to the control group ( p<0.05 ) . CONCLUSIONS Free weights and elastic tubing RT are feasible and effective strategies for improving aspects of health-related fitness in adolescents Objective The aim of this study was to evaluate muscle activity during hamstring rehabilitation exercises performed in training machine compared with elastic resistance . Design Six women and 13 men aged 28–67 yrs participated in a crossover study . Electromyographic ( EMG ) activity was recorded in the biceps femoris and the semitendinosus during the concentric and the eccentric phase of hamstring curls performed with TheraB and elastic tubing and Technogym training machines and normalized to maximal voluntary isometric contraction – EMG ( normalized EMG ) . Knee joint angle was measured using electronic inclinometers . Results Training machines and elastic resistance showed similar high levels of muscle activity ( biceps femoris and semitendinosus peak normalized EMG > 80 % ) . EMG during the concentric phase was higher than during the eccentric phase regardless of exercise and muscle . However , compared with machine exercise , slightly lower ( P < 0.05 ) normalized EMG values were observed using elastic resistance at 30- to 50-degree knee joint angle for the semitendinosus and the biceps femoris during the concentric and the eccentric phase , respectively . Perceived loading ( Borg CR10 ) was significantly higher ( P < 0.001 ) during hamstring curl performed with el Output:

Elastic resistance training is able to promote similar strength gains to conventional resistance training , in different population profiles and using diverse protocol

MS2_1shot467

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: ABSTRACT The aim of the present study was to determine the efficacy of an antibiotic-lock technique in preventing endoluminal catheter-related infection with gram-positive bacteria in neutropenic patients with hematologic malignancies . Patients with nontunneled , multilumen central venous catheters were assigned in a r and omized , double-blinded manner to receive either 10 U of heparin per ml ( 57 patients ) or 10 U of heparin per ml and 25 μg of vancomycin per ml ( 60 patients ) , which were instilled in the catheter lumen and which were allowed to dwell in the catheter lumen for 1 h every 2 days . Insertion-site and hub swabs were taken twice weekly . The primary and secondary end points of the trial were significant colonization of the catheter hub and catheter-related bacteremia , respectively . Significant colonization of the catheter hub occurred in nine ( 15.8 % ) patients receiving heparin ( seven patients were colonized with Staphylococcus epidermidis , one patient was colonized with Staphylococcus capitis , and one patient was colonized withCorynebacterium sp. ) , whereas the catheter hubs of none of the patients receiving heparin and vancomycin were colonized ( P = 0.001 ) . Catheter-related bacteremia developed in four ( 7 % ) patients receiving heparin ( three patients had S. epidermidis bacteremia and one patient had S. capitisbacteremia ) , whereas none of the patients in the heparin and vancomycin group had catheter-related bacteremia ( P = 0.05 ) . The times to catheter hub colonization and to catheter-related bacteremia by the Kaplan-Meier method were longer in patients receiving heparin and vancomycin than in patients receiving heparin alone ( P = 0.004 and P = 0.06 , respectively ) . Our study shows that a solution containing heparin and vancomycin administered by using an antibiotic-lock technique effectively prevents catheter hub colonization with gram-positive bacteria and subsequent bacteremia during chemotherapy-induced neutropenia in patients with hematologic malignancy BACKGROUND We compared the rates of infection in external catheters ( ECs ) and totally implantable devices ( TIDs ) and the effect of timing of insertion in children with acute lymphoblastic leukemia ( ALL ) . PROCEDURE Central line data was collected on all children with ALL referred to the National Guard Hospital , Jeddah . Data was collected retrospectively from 1996 to September 1999 and prospect ively thereafter . Only ECs were inserted prior to 1999 subsequently TIDs were preferred . RESULTS One hundred forty eight children with ALL , mean age 5.1 years had 129 ECs and 70 TIDs inserted for a total of 41,382 catheter days . The overall rate of infective episodes ( infections/1,000 catheter days ) was 3.43 . Of the initial 148 lines 100 developed complications of which 76 ( 51 % ) were secondary to an infective episode . Only young age and treatment protocol were risk factors for first line infections ( P < 0.05 ) . There was weak evidence that ECs had an earlier time to infection compared to TIDs ( P = 0.056 ) . CONCLUSIONS In this study , population central lines were associated with a high rate of infection . Treatment protocol and age were the only significant risk factors when only first lines were considered . Delaying catheter insertion for more than 3 weeks from diagnosis did not reduce the risk of infection Objective .Critically ill neonates are at high risk for vascular catheter – related bloodstream infection ( CRBSI ) , most often caused by coagulase-negative staphylococci . Most CRBSIs with long-term devices derive from intraluminal contaminants . The objective of this study was to ascertain the safety and the efficacy of a vancomycin-heparin lock solution for prevention of CRBSI . Methods .A prospect i ve , r and omized double-blind trial was conducted during 2000–2001 at a community hospital level III NICU . Very low birth weight and other critically ill neonates with a newly placed peripherally inserted central venous catheter were r and omized to have the catheter locked 2 or 3 times daily for 20 or 60 minutes with heparinized normal saline ( n = 43 ) or heparinized saline that contained vancomycin 25 μg/mL ( n = 42 ) . The origin of each nosocomial bloodstream infection ( BSI ) was studied by culturing skin , catheter hubs , and implanted catheter segments and blood cultures , demonstrating concordance by restriction-fragment DNA subtyping . Surveillance axillary and rectal cultures were performed to detect colonization by vancomycin-resistant organisms . The main outcome measures were ( 1 ) CRBSIs and ( 2 ) colonization or infection by vancomycin-resistant Gram-positive bacteria . Results .Two ( 5 % ) of 42 infants in the vancomycin-lock group developed a CRBSI as compared with 13 ( 30 % ) of 43 in the control group ( 2.3 vs 17.8 per 1000 catheter days ; relative risk : 0.13 ; 95 % confidence interval : 0.01–0.57 ) . No vancomycin-resistant enterococci or staphylococci were recovered from any cultures . Vancomycin could not be detected in the blood of infants who did not receive systemic vancomycin therapy . Twenty-six neonates ( 8 vancomycin-lock group , 18 control group ) had at the end of a catheter-lock period asymptomatic hypoglycemia that resolved promptly when glucose-containing intravenous fluids were restarted . Conclusions .Prophylactic use of a vancomycin-heparin lock solution markedly reduced the incidence of CRBSI in high-risk neonates with long-term central catheters and did not promote vancomycin resistance but was associated with asymptomatic hypoglycemia . The use of an anti-infective lock solution for prevention of CRBSI with long-term intravascular devices has achieved proof of principle and warrants selective application in clinical practice In this prospect i ve cohort study , minocycline-ethylenediaminetetraacetate ( M-EDTA ) was used as a lock solution in indwelling ports inserted in 14 children with cancer . No port infections , thrombotic events , or other adverse events were observed , compared with 10 port infections that occurred in 48 control patients whose ports were flushed with heparin . M-EDTA is a promising lock solution in long-term catheters The aim of this study was to determine the efficacy of novobiocin and rifampin as oral antibiotic prophylaxis for the prevention of catheter‐related infection in melanoma patients treated with interleukin‐2 ( IL‐2 ) plus interferon‐α and chemotherapy ( biochemotherapy ) OBJECTIVE To determine whether adding vancomycin to central venous catheter ( CVC ) flush solution would significantly reduce the incidence of bacteremia attributable to luminal colonization with vancomycin-susceptible organisms . STUDY DESIGN Fifty-five children with cancer and eight children given total parenteral nutrition by the surgery or nutrition support services were r and omly assigned to receive a heparin CVC flush solution ( n = 31 ) or a heparin-vancomycin CVC flush solution ( n = 32 ) . RESULTS During 9158 catheter days , 6.5 % of the patients in the heparin group and 15.6 % of the patients in the heparin-vancomycin group had bacteremia attributable to luminal colonization with vancomycin-susceptible organisms ( p = 0.43 ) . The mean rates of bacteremia attributable to luminal colonization with vancomycin-susceptible organisms were 0.6/1000 catheter days in the heparin group and 1.4/1000 catheter days in the heparin-vancomycin group ( p = 0.25 ) . There was no significant difference between the groups when the time to the first episode of bacteremia attributable to luminal colonization with a vancomycin-susceptible organism was compared by means of Kaplan-Meier survival estimates . Streptococcus viridans infection was not attributable to luminal colonization . CONCLUSION The addition of vancomycin to heparin CVC flush solution did not reduce bacteremia with vancomycin-susceptible organisms . Bacteremia with Streptococcus viridans was not related to the use of a CVC Taurolidine has demonstrated inhibition of biofilm formation in vitro . The aim of this study was to compare the effect of catheter locking with taurolidine vs heparin in biofilm formation in central venous catheters . Forty‐eight children with cancer were r and omized to catheter locking by heparin ( n = 22 ) or taurolidine ( n = 26 ) , respectively . After removal , catheters were examined by st and ardized scanning electron microscopy to assess quantitative biofilm formation . Biofilm was present if morphologically typical structures and bacterial cells were identified . Quantitative and semi‐quantitative cultures were also performed . Biofilm was identified in 23 of 26 catheters from the taurolidine group and 21 of 22 catheters from the heparin group . A positive culture was made of six of the catheters locked with taurolidine and heparin , respectively ( p = 0.78 ) . The rate of catheter‐related bloodstream infections ( CRBSI ) was 0.1 per 1000 catheter‐days using taurolidine and 0.9 per 1000 catheter‐days using heparin ( p = 0.03 ) . This r and omized trial confirmed that the use of taurolidine as catheter‐lock compared with heparin reduced the rate of CRBSIs ; this reduction was not related to a reduction in the intraluminal biofilm formation and the rate of bacterial colonization detected by scanning electron microscopy in the two groups Abstract : In all , 88 patients with haematological malignancies requiring Hickman catheters for intensive chemotherapy were r and omized to receive either one single bolus intravenous injection of teicoplanin , 400 mg , or no teicoplanin immediately before insertion of a double‐lumen Hickman catheter . Lower incidences of catheter‐related Gram‐positive sepsis were recorded in patients receiving prophylactic teicoplanin ; exit site infection , tunnel infection and catheter‐related Gram‐positive septicaemia were all reduced . The benefit of prophylactic teicoplanin was observed particularly among patients who were already neutropenic at the time of catheterization . All Gram‐positive organisms isolated from infected skin sites or from blood cultures taken from Hickman catheters were susceptible to teicoplanin . No adverse reaction was reported in any of the patients receiving prophylaxis . Prophylactic teicoplanin , therefore , may be used routinely for patients requiring insertion of Hickman catheters for intensive chemotherapy , to reduce the early incidence of catheter‐related sepsis , particularly during the period of neutropenia following chemotherapy Prospect ively since 11/1997 , all central venous catheter related bacteremias in our dialysis center ( n = 60 ) was recorded . We systematic ally tested antibiotic lock technique using pure heparin ( 1 ml = 5000 Ul ) mixed with antibiotic matched to isolated micro-organism after 15 days of systemic antibiotherapy . During 39 months of study , 27 bacteremias were documented from 23 patients . Seventeen locks in 15 patients were performed after each dialysis sessions during one month . Associated tunnel infection did not allow to stop the lock in 3 cases . In the 12 remaining patients , we observed 4 recurrences for 3 patients after the stop of the lock with the same micro-organism in 3 times/4 without modifications of antibiotics sensibility . No septic metastases were notified and the patency of all catheters were respected . The incidence of bacteremias was 4.6 per 1000 catheters days before the lock and 0.88 after , during a mean observation period of 15 months per patients . Sterilisation of infected catheters seems possible and the incidence of bacteremias is reduce by the lock technique without coming out of septic complications or selected micro-organisms Background Taurolidin/Citrate ( TauroLock ™ ) , a lock solution with broad spectrum antimicrobial activity , may prevent bloodstream infection ( BSI ) due to coagulase-negative staphylococci ( CoNS or ' MRSE ' in case of methicillin-resistant isolates ) in pediatric cancer patients with a long term central venous access device ( CVAD , Port- or/Broviac-/Hickman-catheter type ) . Methods In a single center prospect i ve 48-months cohort study we compared all patients receiving anticancer chemotherapy from April 2003 to March 2005 ( group 1 , heparin lock with 200 IU/ml sterile normal saline 0.9 % ; Canusal ® Wockhardt UK Ltd , Wrexham , Wales ) and all patients from April 2005 to March 2007 ( group 2 ; taurolidine 1.35%/Sodium Citrate 4 % ; TauroLock ™ , Tauroph Output:

There was no benefit to administering antibiotics before the insertion of long-term CVCs to prevent Gram positive catheter-related infections . Flushing or locking long-term CVCs with a combined antibiotic and heparin solution appeared to reduce Gram positive catheter-related sepsis experienced in people at risk of neutropenia through chemotherapy or disease . Due to insufficient data it was not clear whether this applied equally to TCVCs and totally implanted devices ( TIDs ) , or equally to adults and children .

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***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: PURPOSE this study was conducted to evaluate the feasibility and acceptability of a managed-care approach ( group visits ) on delivering care to uninsured or inadequately insured patients with type 2 diabetes . METHODS One hundred twenty patients with uncontrolled type 2 diabetes were r and omly assigned to receive care in group visits or usual care for 6 months . At baseline , 3 months , and 6 months , the feasibility and acceptability of this model of healthcare delivery were assessed through the patients ' responses to the Primary Care Assessment Tool and the Trust in Physician Scale . Attendance records were kept for each group . RESULTS Patients who received care in group visits showed an improved sense of trust in their physician compared with patients who continued to receive usual care . There was a tendency for patients in groups to report better coordination of their care , better community orientation , and more culturally competent care . Patient attendance at the groups also indicated good acceptance of this form of healthcare delivery . CONCLUSIONS Group visits were feasible and acceptable to these uninsured and inadequately insured patients with uncontrolled type 2 diabetes and fostered an improved sense of trust in their physician PURPOSE The purpose of the study was to evaluate perceptions of care delivered through group visits to disadvantaged patients with type 2 diabetes . METHODS One hundred eighty-six patients with uncontrolled type 2 diabetes were r and omly assigned to receive care in group visits or usual care for 12 months . Their perceptions of the care they received were measured at baseline and 6 and 12 months by the Primary Care Assessment Tool ( PCAT ) , the Diabetes-Specific Locus of Control ( DLC ) survey , and the Trust in Physician Scale ( TPS ) . RESULTS Compared to patients in usual care , group visit patients ' PCAT scores were higher in the domains of ongoing care ( P = .001 ) , community orientation ( P < .0001 ) , and cultural competence ( P = .022 ) . In addition , group patients had higher scores for the Powerful-Other Health Professional subscale of the DLC survey ( P = .010 ) . CONCLUSIONS Patients assigned to group visits had generally more positive perceptions about their care in the areas of ongoing care , community orientation of care , and cultural competence of care than did those in usual care . The perception that one 's health professional is powerful , however , has been associated with a reluctance of patients to make medication changes on their own in previous studies . These findings suggest the need for modification in the way that group visits are conducted to empower and activate patients while still delivering continuous , culturally competent , and community-oriented care BACKGROUND Poor quality of information transfer about the benefits and risks of statin drug use may result in patients not making informed decisions that they can act on in a timely fashion . METHODS The effect of a decision aid about statin drugs on treatment decision making in 98 patients with diabetes was determined in a cluster r and omized trial of decision aid vs control pamphlet , with concealed allocation , blinding of participants to study goals , and adherence to the intention-to-treat principle . Twenty-one endocrinologists conducted specialty outpatient metabolic consultations . Patients in the intervention group received Statin Choice , a tailored decision aid that presents the estimated 10-year cardiovascular risk , the absolute risk reduction with use of statin drugs , and the disadvantages of using statin drugs . Patients in the control group received the institution 's pamphlet about cholesterol management . We measured acceptability , knowledge about options and cardiovascular risk , and decisional conflict immediately after the visit , and adherence to pill taking was measured 3 months later . RESULTS Patients favored using the decision aid ( odds ratio [ OR ] , 2.8 ; 95 % confidence interval [ CI ] , 1.2 - 6.9 ) ; patients who received the decision aid ( n = 52 ) knew more ( difference , 2.4 of 9 points ; 95 % CI , 1.5 - 3.3 ) , had better estimated cardiovascular risk ( OR , 22.4 ; 95 % CI , 5.9 - 85.6 ) and potential absolute risk reduction with statin drugs ( OR , 6.7 ; 95 % CI , 2.2 - 19.7 ) , and had less decisional conflict ( difference , -10.6 ; 95 % CI , -15.4 to -5.9 on a 100-point scale ) than did patients in the control group ( n = 46 ) . Of 33 patients in the intervention group taking statin drugs at 3 months , 2 reported missing 1 dose or more in the last week compared with 6 of 29 patients in the control group taking statin drugs ( OR , 3.4 ; 95 % CI , 1.5 - 7.5 ) . CONCLUSIONS A decision aid enhanced decision making about statin drugs and may have favorably affected drug adherence OBJECTIVE Assess use of and reactions to an interactive , tailored CD-ROM to enhance oncologist-patient communication . METHODS Participating oncologists ( n=48 ) agreed to have patient interactions audio recorded , be r and omly assigned to receive/not receive a CD-ROM , have CD-ROM usage monitored ( intervention group ) and complete a follow-up survey . RESULTS Twenty-one of 24 in the intervention group reported using the CD-ROM . Median usage minutes were 63.8 . At follow-up , oncologists rated the CD-ROM from 1 ( " none " or " not at all helpful " ) to 5 ( " a great deal " or " very helpful " ) . Mean responses were : 3.1 and 3.0 for 2 items assessing perceived impact on communications , 3.8 - 4.0 for 6 items assessing perceived helpfulness , 3.0 and 3.10 for 2 items assessing impact on affecting oncologists ' communication with patients and assistance with challenging conversations , respectively , and 3.6 for whether using the CD-ROM was worth their time . Self-report of how much oncologists had used the covered skills before and after intervention showed a perceived increase ( 2.8 before and 3.2 after ) . CONCLUSIONS Findings suggest the tailored interactive CD-ROM has promise for use and acceptance among oncologists . PRACTICE IMPLICATION S If ultimately found effective in changing oncologist 's communication with patients , the CD-ROM 's widespread dissemination should be explored Abstract BACKGROUND : Disclosure of medical errors is encouraged , but research on how patients respond to specific practice s is limited . OBJECTIVE : This study sought to determine whether full disclosure , an existing positive physician-patient relationship , an offer to waive associated costs , and the severity of the clinical outcome influenced patients ’ responses to medical errors . PARTICIPANTS : Four hundred and seven health plan members participated in a r and omized experiment in which they viewed video depictions of medical error and disclosure . DESIGN : Subjects were r and omly assigned to experimental condition . Conditions varied in type of medication error , level of disclosure , reference to a prior positive physician-patient relationship , an offer to waive costs , and clinical outcome . MEASURES : Self-reported likelihood of changing physicians and of seeking legal advice ; satisfaction , trust , and emotional response . RESULTS : Nondisclosure increased the likelihood of changing physicians , and reduced satisfaction and trust in both error conditions . Nondisclosure increased the likelihood of seeking legal advice and was associated with a more negative emotional response in the missed allergy error condition , but did not have a statistically significant impact on seeking legal advice or emotional response in the monitoring error condition . Neither the existence of a positive relationship nor an offer to waive costs had a statistically significant impact . CONCLUSIONS : This study provides evidence that full disclosure is likely to have a positive effect or no effect on how patients respond to medical errors . The clinical outcome also influences patients ’ responses . The impact of an existing positive physician-patient relationship , or of waiving costs associated with the error remains uncertain BACKGROUND Concern regarding financial conflict of interest for physicians has led to calls for disclosure of financial incentives to patients . However , limited data on the outcomes of disclosure exist to guide policy . METHODS This r and omized trial was conducted among 8000 adult patients at 2 multispecialty group practice s based in the Boston , Mass , and Los Angeles , Calif , areas . Intervention patients were mailed a compensation disclosure letter written by the chief medical officer of their physician group , and all patients were surveyed approximately 3 months later . RESULTS Disclosure patients were significantly more able to identify correctly the compensation model of their primary care physician , in Boston ( adjusted odds ratio , 2.30 ; 95 % confidence interval , 1.92 - 2.75 ) and in Los Angeles ( adjusted odds ratio , 1.37 ; 95 % confidence interval , 1.03 - 1.82 ) . Disclosure patients also had more confidence in their ability to judge the possible influence of incentives on their health care : in Boston , 32.5 % vs 17.8 % ( P<.001 ) ; and in Los Angeles , 31.8 % vs 26.4 % ( P = .20 ) . The disclosure intervention did not change trust in primary care physicians overall . However , of patients who remembered receiving the disclosure , 21.4 % in Boston and 24.4 % in Los Angeles responded that the disclosure had increased trust either greatly or somewhat , while in both cities less than 5 % of patients responded that the information decreased trust . Patients ' loyalty to their physician group was higher among disclosure patients in Boston ( 73.4 % vs 70.2 % ; P = .03 ) and Los Angeles ( 74.1 % vs 66.9 % ; P = .08 ) . CONCLUSIONS Among diverse patient population s , a single mailed disclosure letter from physician groups was associated with improved knowledge of physicians ' compensation models . Patients ' trust in their physicians was unharmed , and their loyalty to their physician group was strengthened . For physician groups with similar compensation programs , disclosure to patients should be considered an effective method to enhance the patient-physician relationship BACKGROUND Many physicians receive financial incentives to limit their ordering of expensive tests and procedures . While Medicare m and ates disclosure of incentives , it is not clear how to inform patients without undermining trust . METHODS Our objective was to determine public opinion about physician disclosure of financial incentives and how this might be best communicated to patients . The 2002 General Social Survey included 2765 interviews from a probability sample of English-speaking US households . The interview included questions about financial incentives and an audiotaped scenario of a physician discussing the impact of financial incentives on ordering a magnetic resonance image . Respondents heard 1 of 6 r and omly selected disclosure strategies . The measurements included ratings of trust , satisfaction , agreement with the physician 's decision , and likelihood of remaining with the physician/health plan or seeking a second opinion . RESULTS Nearly half ( 48.8 % ) of respondents had previously heard of financial incentives to limit test ordering . Of the respondents , 94.8 % wanted to be told about incentives , at the time of enrollment in a health plan ( 80.5 % ) , by a health plan representative ( 44.8 % ) , their physician ( 17.1 % ) , or both ( 38.1 % ) . Of the 6 different disclosure strategies , " addressing emotions " and " negotiation " were associated with the best outcomes , while " common enemy " and " denying influences " were most negatively perceived . Black and Hispanic subjects were less likely to express satisfaction or trust and more likely to disenroll or seek a second opinion . CONCLUSIONS The public wants information about physician financial incentives . Specific communication styles enhance how this information is conveyed to patients , increasing trust and supporting the physician-patient relationship OBJECTIVE To assess the impact of patient-centered communication ( PCC ) behaviors on patients ' evaluations of physicians and acceptance of clinical recommendations . METHODS We r and omized 248 patients to view video-recorded , st and ardized vignettes , depicting a cardiologist using a high vs. low degree of PCC while recommending bypass surgery to a patient with angina and 3-vessel coronary artery disease . We compared patients ' ratings of the physician and their decision making in response to the physician 's recommendation , for high vs. low PCC vignettes . RESULTS Patients viewing high PCC vignettes rated the video physician more favorably overall ( 3.01 vs. 2.12 , p<0.001 ) and as more competent ( 3.22 vs. 2.66 , p<0.001 ) and trustworthy ( 2.93 vs. 2.28 , p<0.001 ) than those viewing the low PCC version ( 0 - 4 range for all scales ) . Patients viewing the high PCC version more frequently said they would undergo bypass surgery ( 96 % vs. 74 % , p<0.001 ) if they were the patient in the video . CONCLUSION Patients expressed greater confidence in physicians who used more PCC behaviors , and greater willingness to accept an evidence -based recommendation . PRACTICE IMPLICATION S PCC may make physicians more effective in the delivery of evidence -based care Existing scales to measure trust in physicians have differing content and limited testing . To improve on these measures , a large item pool ( n = 78 ) was generated following a detailed conceptual model and expert review . After pilot testing , the best-performing items were vali date d with a r and om national sample ( n = 9 ) and a regional sample of HMO members ( n = 99 ) . Various psychometric tests produced a 10-item unidimensional scale consistent with most aspects of the conceptual model . Compared with previous scales , the Wake Forest physician trust scale has a somewhat improved combination of internal consistency , variability , and discriminability . The scale is more strongly correlated with satisfaction , desire to remain with a physician , willingness to recommend to friends , and not seeking second opinions ; it is less correlated with insurer trust , membership in managed Output:

Overall , there remains insufficient evidence to conclude that any intervention may increase or decrease trust in doctors . This may be due in part to the sensitivity of trust instruments , and a ceiling effect , as trust in doctors is generally high .

MS2_1shot469

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: The main aim of the present experiment was to determine whether extensive musical training facilitates pitch contour processing not only in music but also in language . We used a parametric manipulation of final notes ' or words ' fundamental frequency ( F0 ) , and we recorded behavioral and electrophysiological data to examine the precise time course of pitch processing . We compared professional musicians and nonmusicians . Results revealed that within both domains , musicians detected weak F0 manipulations better than nonmusicians . Moreover , F0 manipulations within both music and language elicited similar variations in brain electrical potentials , with overall shorter onset latency for musicians than for nonmusicians . Finally , the scalp distribution of an early negativity in the linguistic task varied with musical expertise , being largest over temporal sites bilaterally for musicians and largest central ly and over left temporal sites for nonmusicians . These results are taken as evidence that extensive musical training influences the perception of pitch contour in spoken language The idea that music makes you smarter has received considerable attention from scholars and the media . The present report is the first to test this hypothesis directly with r and om assignment of a large sample of children ( N = 144 ) to two different types of music lessons ( keyboard or voice ) or to control groups that received drama lessons or no lessons . IQ was measured before and after the lessons . Compared with children in the control groups , children in the music groups exhibited greater increases in full-scale IQ . The effect was relatively small , but it generalized across IQ subtests , index scores , and a st and ardized measure of academic achievement . Unexpectedly , children in the drama group exhibited substantial pre- to post-test improvements in adaptive social behavior that were not evident in the music groups We conducted a longitudinal study with 32 nonmusician children over 9 months to determine 1 ) whether functional differences between musician and nonmusician children reflect specific predispositions for music or result from musical training and 2 ) whether musical training improves nonmusical brain functions such as reading and linguistic pitch processing . Event-related brain potentials were recorded while 8-year-old children performed tasks design ed to test the hypothesis that musical training improves pitch processing not only in music but also in speech . Following the first testing sessions nonmusician children were pseudor and omly assigned to music or to painting training for 6 months and were tested again after training using the same tests . After musical ( but not painting ) training , children showed enhanced reading and pitch discrimination abilities in speech . Remarkably , 6 months of musical training thus suffices to significantly improve behavior and to influence the development of neural processes as reflected in specific pattern of brain waves . These results reveal positive transfer from music to speech and highlight the influence of musical training . Finally , they demonstrate brain plasticity in showing that relatively short periods of training have strong consequences on the functional organization of the children 's brain The purpose of the present study was to determine the efficacy of using music as a remedial strategy to enhance the reading skills of second- grade students and students who have been identified as having a specific learning disability ( SLD ) in reading . First , an intensive short-term music curriculum was design ed to target reading comprehension and vocabulary skills at the second grade level . The curriculum was then implemented in classrooms at two public schools in the Southeast . Reading skills were evaluated pre and post curriculum intervention via the vocabulary and reading comprehension subtests of the Gates-MacGinitie Reading Test for second grade . Analysis of pre/posttest data revealed that students with a specific disability in reading improved significantly from pre to post on all three subtests : word decoding ( p = .04 ) , word knowledge ( p = .01 ) , reading comprehension ( p = .01 ) , and test total ( p = .01 ) . Paired t-tests revealed that for 2nd grade students , both treatment and control classes improved significantly from pre to post on the subtests word decoding , word knowledge , and test total . While both classes made gains from pre to post on the subtest , reading comprehension , neither improved significantly . Analysis of Covariance revealed that the treatment class made greater gains pre to post than the control class on all 3 subtests ( Including reading comprehension ) , and significantly greater gains on the subtest , word knowledge ( p = .01 ) Output:

There is no evidence available from r and omized controlled trials on which to base a judgment about the effectiveness of music education for the improvement of reading skills in children and adolescents with dyslexia .

MS2_1shot470

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Background — Patients with repaired coa rct ation are at increased risk of hypertension and cardiovascular disease despite successful repair . We studied the function of conduit arteries in upper and lower limbs of patients late after successful coa rct ation repair and its relation to age at surgery . Methods and Results —Flow-mediated dilatation ( FMD ) and the dilatation after sublingual nitroglycerin ( NTG , 25 & mgr;g ) were measured by using high-resolution ultrasound in the brachial artery in 64 coa rct ation patients ( 44 males and 20 females , aged 19±10 years ; median age at operation 4 months ) and 45 control subjects ( 28 males and 17 females , aged 19±10 years ) and in the posterior tibial artery in 37 patients and 22 control subjects . Arterial stiffness was determined by pulse-wave velocity ( PWV ) of the brachioradial and femoral-dorsalis pedis tracts . Patients , compared with control subjects , had lower brachial FMD ( 7.16±3.4 % versus 8.62±2.3 % , respectively;P = 0.02 ) and NTG ( 11.46±4.3 % versus 13.21±4.6 % , respectively;P = 0.046 ) and higher brachioradial PWV ( 9.17±3.1 versus 8.06±1.9 m/s , respectively;P = 0.05 ) . In contrast , posterior tibial FMD , NTG , and lower limb PWV were comparable . Age ( months ) at the time of repair was related to brachioradial PWV ( r = 0.42 , P = 0.002 ) but not to brachial FMD or NTG . Conclusions — Patients with repaired aortic coa rct ation have impaired conduit artery function , with abnormal responses to flow and NTG , and increased vascular stiffness confined to the upper part of the body . Early repair is associated with preserved elastic properties of conduit arteries , but reduced reactivity remains Introduction : Since the 1980s , stent implantation has evolved as an important therapeutic strategy for coa rct ation of the aorta . However , available data is frequently flawed by short follow‐up , lack of adequate follow‐up imaging , and retrospective nature of data collection . Methods : Data was prospect ively collected using a multicenter registry congenital cardiovascular interventional study consortium ( CCISC ) . Between 2000 and 2009 , 302 patients from 34 centers with a median weight of 58 kg underwent stent implantation for coa rct ation . Eligible patients ( 44 % ) completed intermediate follow‐up ( 3–18 months ) with integrated imaging ( cath , CT , MRI ) , whereas 21 % completed long‐term follow‐up ( > 18–60 months ) . Procedural success was defined as UL/LL systolic gradient of less than 20 mm Hg , lack of significant recurrent obstruction , and freedom from unplanned repeat intervention . Results : Acute procedural success was 96 % . Cumulative intermediate success was 86 % , and cumulative long‐term success was 77 % . Unplanned repeat interventions were required in 4 % , and aortic wall complications were seen in 1 % of patients ( dissection n = 1 and aneurysm n = 3 ) . Other adverse events ( n = 15 ) occurred mainly acutely and included technical complications such as stent malposition ( n = 9 ) . At long‐term follow‐up , 23 % of patients continued to have systolic blood pressure above the 95th centile , 9 % had an upper‐to‐lower limb blood pressure gradient in excess of 20 mm Hg , and 32 % were taking antihypertensive medication . Conclusions : This study documented acute , intermediate , and long‐term outcome data comparable or superior with other surgical or interventional series . However , even with successful initial stent therapy , patients continue to require long‐term follow‐up and have associated long‐term morbidity , relating to aortic wall complications , systemic hypertension , recurrent obstruction as well as need for repeat intervention . © 2010 Wiley‐Liss , Although reference values for ambulatory blood pressure ( ABP ) monitoring have been investigated in several population studies , these values were derived from cross-sectional observations and were based merely on the statistical distribution of blood pressure values . Therefore , we conducted a prospect i ve cohort study to identify reference values for 24-hour ABP in relation to prognosis . We obtained measurements of 24-hour ABP for 1542 subjects ( 565 men ) aged 40 years and over in a general population of a rural Japanese community and then followed-up their survival status . There were 117 deaths during the follow-up period ( mean , 6.2 years ) . The association between baseline 24-hour ABP values and mortality , examined by the Cox proportional hazards regression model adjusted for possible confounding factors , showed a better fit with a second-degree equation than with a first-degree equation . On the basis of the results of this analysis , we identified the following reference values as the optimal blood pressure ranges that predict the best prognosis : 120 to 133 mm Hg for systolic blood pressure and 65 to 78 mm Hg for diastolic blood pressure . 24-Hour ABP values > 134/79 mm Hg and < 119/64 mm Hg were related to increased risks for cardiovascular and noncardiovascular mortality , respectively . This is the first report to propose reference values for 24-hour ABP based on a prognostic criterion OBJECTIVES The purpose of this study was to evaluate the effect of ramipril on endothelial function and inflammatory process in a group of normotensive subjects with successfully repaired coa rct ation of the aorta ( SCR ) . BACKGROUND Subjects with SCR experience higher long-term cardiovascular risk as a result of the relapse of arterial hypertension or owing to nonreversible structural changes in the pre-coa rct ation arterial tree . These subjects experience endothelial dysfunction in the right forearm and appear to have elevated levels of proatherogenic inflammatory markers , even in the absence of arterial hypertension . METHODS Twenty young individuals age 27.3 + /- 2.4 years old with SCR 13.9 + /- 2.2 years previously , received ramipril 5 mg/day for 4 weeks in a r and omized , cross-over , controlled trial . Endothelial function was evaluated in the right forearm by gauge-strain plethysmography , and serum levels of interleukin (IL)-1b , IL-6 , soluble CD40 lig and ( sCD40L ) , and soluble vascular cell adhesion molecule (sVCAM)-1 were determined by enzyme-linked immunosorbent assay . RESULTS Ramipril improved endothelial function ( p < 0.001 ) and decreased the expression of proinflammatory cytokine IL-6 ( p < 0.05 ) and sCD40L ( p < 0.01 ) . Furthermore , ramipril decreased serum levels of sVCAM-1 ( p < 0.01 ) but failed to affect serum levels of C-reactive protein . These effects were independent of blood pressure lowering . CONCLUSIONS Ramipril reversed the impaired endothelial function and decreased the expression of proinflammatory cytokine IL-6 , sCD40L , and adhesion molecules in normotensive subjects with SCR . These findings imply that ramipril treatment may have antiatherogenic effects in subjects with SCR , even in the absence of arterial hypertension OBJECTIVES This study was design ed to investigate the influence of aortic arch geometry on vascular remodeling after anatomically successful repair of coa rct ation of the aorta ( CoA ) . BACKGROUND Abnormalities of the precoa rct ation vasculature are known to occur after CoA repair and appear related to adverse outcomes . The influence of aortic arch geometry on such abnormalities is unknown . METHODS Sixty-three postcoa rct ectomy subjects ( age 15.9 + /- 6.3 years ) were compared with 63 control volunteers . Aortic arch shape was characterized on magnetic resonance imaging using both qualitative classification , identifying 3 subtypes of arch geometry ( Gothic , Crenel , Romanesque ) , and a quantitative index , height/width ratio ( H/W ) of the aorta . Using ultrasound , we measured carotid artery intima-media thickness ( IMT ) and stiffness index and distensibility , as well as right brachial artery flow-mediated dilation ( FMD ) and glyceryl trinitate (GTN)-induced dilatation , to assess the precoa rct ation vasculature of these subjects . RESULTS Gothic arch type was associated with higher carotid IMT and stiffness index , lower carotid distensibility ( p < 0.001 for all ) , and lower brachial reactivity ( FMD , p < 0.01 ; GTN response , p < 0.001 ) compared with Crenel and Romanesque geometries and with control subjects . The height/width ratio was also significantly related to these vascular abnormalities . Even in CoA subjects with Romanesque arch geometry , arterial function and stiffness parameters were significantly impaired compared with control subjects . CONCLUSIONS In young adult survivors of anatomically successful CoA repair , a gothic-type aortic arch with high H/W is associated with abnormal IMT , higher aortic stiffness index , and impaired arterial reactivity in the pre-CoA vasculature Chronic hypertension is a major concern in adults who have undergone resection of coa rct ation of the aorta ( CoA ) in childhood . In otherwise healthy subjects , exercise-induced hypertension is prognostic for chronic hypertension ; however , the prognostic value in patients with CoA remains unknown . The aim of the present study was to evaluate the predictive value of exercise-induced hypertension for chronic hypertension in these patients . In the present prospect i ve follow-up study , 74 patients with CoA ( 58 % men , age 30.9 ± 9.5 years ) underwent ambulatory blood pressure ( BP ) monitoring and exercise testing twice from 2001 to 2009 with a follow-up period of 6.3 ± 0.8 years . Hypertension was defined as a mean systolic BP ≥140 mm Hg and /or mean diastolic BP ≥90 mm Hg or the need for antihypertensive treatment . Exercise-induced hypertension was defined as a mean systolic BP of < 140 mm Hg and peak exercise systolic BP of ≥200 mm Hg . At baseline , 27 patients ( 36 % ) were hypertensive , 11 ( 15 % ) had exercise-induced hypertension , and 36 ( 49 % ) were normotensive . At follow-up , all 27 hypertensive patients remained hypertensive . Of the 11 with exercise-induced hypertension , 7 ( 64 % ) had developed chronic hypertension , and 4 ( 36 % ) continued to have exercise-induced hypertension . Of the 36 normotensive patients , 7 ( 19 % ) had developed hypertension , 12 ( 33 % ) had developed exercise-induced hypertension , and 17 ( 47 % ) remained normotensive . On multivariate analysis , baseline maximum exercise systolic BP was independently associated with the mean systolic BP at follow-up ( β = 0.13 , p = 0.005 ) . In conclusion , the maximum exercise systolic BP was a predictor for chronic hypertension in patients with CoA. These findings demonstrate the clinical importance of exercise-induced hypertension and warrant additional study into the long-term consequences of exercise-induced hypertension and the potential beneficial role of early antihypertensive treatment in adult patients after CoA repair with exercise-induced hypertension Even after successful repair , hypertension is one of the main determinants of cardiovascular morbidity and mortality in patients with aortic coa rct ation ( CoA ) . We compared the effect of c and esartan ( angiotensin II receptor blockade ) and metoprolol ( beta-adrenergic receptor blockade ) on blood pressure , large artery stiffness , and neurohormonal status in hypertensive patients after repair of CoA. In the present open-label , crossover study , hypertensive patients after CoA repair were first r and omly assigned to treatment with c and esartan 8 mg or metoprolol 100 mg once per day . After 8 weeks of treatment with one of the drugs , the other treatment was given for 8 weeks . The treatment effects were assessed with 24-hour ambulatory blood pressure monitoring , measurement of large artery stiffness , and neurohormonal plasma levels at baseline and after 8 weeks of either treatment . Sixteen patients ( mean age 37 + /- 12 years , 26 + /- 15 years after repair , 63 % men ) completed the study . The 24-hour mean arterial pressure at baseline was 97.7 + /- 6.2 mm Hg . Metoprolol ( mean dose 163 + /- 50 mg/day ) decreased the mean arterial pressure ( 7.0 + /- 4.2 and 4.1 + /- 3.6 mm Hg , respectively ) more than did c and esartan ( mean dose 13 + / Output:

Hypertension remains a common complication following aortic coa rct ation repair .

MS2_1shot471

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: PURPOSE To assess in a prospect i ve trial the feasibility and late toxicity of hypofractionated radiotherapy ( RT ) for prostate cancer . METHODS AND MATERIAL S Eligible patients had clinical stage T1c-2cNXM0 disease . They received 60 Gy in 20 fractions over 4 weeks with intensity-modulated radiotherapy including daily on-line image guidance with intraprostatic fiducial markers . RESULTS Between June 2001 and March 2004 , 92 patients were treated with hypofractionated RT . The cohort had a median prostate-specific antigen value of 7.06 ng/mL. The majority had Gleason grade 5 - 6 ( 38 % ) or 7 ( 59 % ) disease , and 82 patients had T1c-T2a clinical staging . Overall , 29 patients had low-risk , 56 intermediate-risk , and 7 high-risk disease . Severe acute toxicity ( Grade 3 - 4 ) was rare , occurring in only 1 patient . Median follow-up was 38 months . According to the Phoenix definition for biochemical failure , the rate of biochemical control at 14 months was 97 % . According to the previous American Society for Therapeutic Radiology and Oncology definition , biochemical control at 3 years was 76 % . The incidence of late toxicity was low , with no severe ( Grade > or =3 ) toxicity at the most recent assessment . CONCLUSIONS Hypofractionated RT using 60 Gy in 20 fractions over 4 weeks with image guidance is feasible and is associated with low rates of late bladder and rectal toxicity . At early follow-up , biochemical outcome is comparable to that reported for conventionally fractionated controls . The findings are being tested in an ongoing , multicenter , Phase III trial PURPOSE To compare the toxicity and efficacy of hypofractionated ( 62 Gy/20 fractions/5 weeks , 4 fractions per week ) vs. conventional fractionation radiotherapy ( 80 Gy/40 fractions/8 weeks ) in patients with high-risk prostate cancer . METHODS AND MATERIAL S From January 2003 to December 2007 , 168 patients were r and omized to receive either hypofractionated or conventional fractionated schedules of three-dimensional conformal radiotherapy to the prostate and seminal vesicles . All patients received a 9-month course of total and rogen deprivation ( TAD ) , and radiotherapy started 2 months thereafter . RESULTS The median ( range ) follow-up was 32 ( 8 - 66 ) and 35 ( 7 - 64 ) months in the hypofractionation and conventional fractionation arms , respectively . No difference was found for late toxicity between the two treatment groups , with 3-year Grade 2 rates of 17 % and 16 % for gastrointestinal and 14 % and 11 % for genitourinary in the hypofractionation and conventional fractionation groups , respectively . The 3-year freedom from biochemical failure ( FFBF ) rates were 87 % and 79 % in the hypofractionation and conventional fractionation groups , respectively ( p = 0.035 ) . The 3-year FFBF rates in patients at a very high risk ( i.e. , pretreatment prostate-specific antigen ( iPSA ) > 20 ng/mL , Gleason score > or=8 , or T > or=2c ) , were 88 % and 76 % ( p = 0.014 ) in the former and latter arm , respectively . The multivariate Cox analysis confirmed fractionation , iPSA , and Gleason score as significant prognostic factors . CONCLUSIONS Our findings suggest that late toxicity is equivalent between the two treatment groups and that the hypofractionated schedule used in this trial is superior to the conventional fractionation in terms of FFBF PURPOSE The aim of this study was to compare the toxicity and efficacy of radiation therapy ( RT ) for localized carcinoma of the prostate , using a hypofractionated ( 55 Gy/20 fractions/4 weeks ) vs. a conventionally fractionated ( 64 Gy/32 fractions/6.5 weeks ) dose schedule . METHODS AND MATERIAL S A total of 217 patients were r and omized to either the hypofractionated ( 108 patients ) or the conventional ( 109 patients ) dose schedule , with planning with two-dimensional ( 2D ) CT scan planning methodology in the majority of cases . All patients were followed for a median of 48 ( 6 - 108 ) months . Gastrointestinal ( GI ) and genitourinary ( GU ) toxicity was evaluated before RT and after its completion using modified late effects of normal tissue-subjective , objective , management , analytic ( LENT-SOMA ) scales and the European Organization for Research and Treatment of Cancer sexual function question naire . Efficacy of RT based on clinical , radiologic , and prostate-specific antigen data were also evaluated at baseline and after RT . RESULTS Gastrointestinal and GU toxicity persisted 5 years after RT and did not differ between the two dose schedules other than in regard to urgency of defecation . However , 1-month GI toxicity was not only worse in patients with the hypofractionated RT schedule but also adversely affected daily activities . Nadir prostate-specific antigen values occurred at a median of 18.0 ( 3.0 - 54.0 ) months after RT . A total of 76 biochemical relapses , with or without clinical relapses , have occurred since ; of these , 37 were in the hypofractionated and 39 in the conventional schedule . The 5-year biochemical + /- clinical relapse-free and overall survival was 55.9 % and 85.3 % respectively for all patients , and did not differ between the two schedules . CONCLUSIONS Radiation therapy for prostate carcinoma causes persistent GI toxicity that is largely independent of the two dose schedules . The hypofractionated schedule is equivalent in efficacy to the conventional schedule Purpose To compare the acute toxicities in radical treatment of prostate cancer between conventional schedule ( C-ARM ) with 78 Gy/39 fractions and hypofractionation conformal treatment ( H-ARM ) with 69 Gy/23 fractions . Methods and material This prospect i ve double arm study consisted of 217 patients with prostate cancer , 112 in H-ARM and 105 in C-ARM arm . C-ARM received conventional six- field conformal radiotherapy with 78 Gy in 39 fractions while H-ARM received hypofractionation with 69 Gy in 23 fractions . Weekly assessment of acute reactions was done during treatment and with one , and 3 months using RTOG scale . Univariated analysis was performed to evaluate differences between the incidences of acute reaction in the treatment arms . Variables with p value less than 0.1 were included in the multivariated logistic regression . Results There was no difference between H-ARM versus C-ARM for severity and incidence in genitourinary ( GU ) and gastrointestinal ( GI ) acute toxicity . During the treatment comparing H-ARM with C-ARM no differences was observed for GI toxicity ( grade 0–3 ; H-ARM = 45.5 % , 34 % , 18.7 % and 1.8 % versus C-ARM = 47.6 % , 35.2 % , 17.2 % and 0 ) . For acute GU toxicity no difference was detected between H-ARM ( grade 0–3 ; 22.3 % , 54.5 % , 18.7 % and 4.5 % ) and C-ARM ( grade 0–3 ; 25.8 % , 53.3 % , 17.1 % and 3.8%).At the 3- months follow-up , persistent Grade > = 2 acute GU and GI toxicity were 2.5 % and 1.8 % in H-ARM versus 5.7 % and 3 % in C-ARM ( p > 0.05 ) . In univariated and multivariated analyses , there was not any dosimetric predictor for GI and GU toxicity . Conclusions Our data demonstrate that hypofractionated radiotherapy achieving high biological effective dose using conformal radiotherapy is feasible for prostate cancer , being well tolerated with minimal severe acute toxicity OBJECTIVE To report late toxicity outcomes from a r and omized trial comparing conventional and hypofractionated prostate radiation therapy and to identify dosimetric and clinical parameters associated with late toxicity after hypofractionated treatment . METHODS AND MATERIAL S Men with localized prostate cancer were enrolled in a trial that r and omized men to either conventionally fractionated intensity modulated radiation therapy ( CIMRT , 75.6 Gy in 1.8-Gy fractions ) or to dose-escalated hypofractionated IMRT ( HIMRT , 72 Gy in 2.4-Gy fractions ) . Late ( ≥90 days after completion of radiation therapy ) genitourinary ( GU ) and gastrointestinal ( GI ) toxicity were prospect ively evaluated and scored according to modified Radiation Therapy Oncology Group criteria . RESULTS 101 men received CIMRT and 102 men received HIMRT . The median age was 68 , and the median follow-up time was 6.0 years . Twenty-eight percent had low-risk , 71 % had intermediate-risk , and 1 % had high-risk disease . There was no difference in late GU toxicity in men treated with CIMRT and HIMRT . The actuarial 5-year grade ≥2 GU toxicity was 16.5 % after CIMRT and 15.8 % after HIMRT ( P=.97 ) . There was a nonsignificant numeric increase in late GI toxicity in men treated with HIMRT compared with men treated with CIMRT . The actuarial 5-year grade ≥2 GI toxicity was 5.1 % after CIMRT and 10.0 % after HIMRT ( P=.11 ) . In men receiving HIMRT , the proportion of rectum receiving 36.9 Gy , 46.2 Gy , 64.6 Gy , and 73.9 Gy was associated with the development of late GI toxicity ( P<.05 ) . The 5-year actuarial grade ≥2 GI toxicity was 27.3 % in men with R64.6Gy ≥ 20 % but only 6.0 % in men with R64.6Gy < 20 % ( P=.016 ) . CONCLUSIONS Dose-escalated IMRT using a moderate hypofractionation regimen ( 72 Gy in 2.4-Gy fractions ) can be delivered safely with limited grade 2 or 3 late toxicity . Minimizing the proportion of rectum that receives moderate and high dose decreases the risk of late rectal toxicity after this hypofractionation regimen Purpose : To compare acute gastrointestinal ( GI ) and genitourinary ( GU ) toxicity between patient groups with localized prostate adenocarcinoma , treated with conventionally fractionated ( CFRT ) and hypofractionated ( HFRT ) three-dimensional conformal external-beam radiotherapy ( 3D-CRT ) . Patients and Methods : 91 patients were enrolled into a r and omized study with a minimum follow-up of 3 months . 44 men in the CFRT arm were irradiated with 74 Gy in 37 fractions at 2 Gy per fraction for 7.5 weeks . 47 men in the HFRT arm were treated with 57 Gy in 17 fractions for 3.5 weeks , given as 13 fractions of 3 Gy plus four fractions of 4.5 Gy . The clinical target volume ( CTV ) included the prostate and the base of seminal vesicles . The CTV-to-PTV ( planning target volume ) margin was 8–10 mm . Study patients had portal imaging and /or simulation performed on the first fractions and repeated at least weekly . Results : No acute grade 3 or 4 toxicities were observed . The grade 2 GU acute toxicity proportion was significantly lower in the HFRT arm : 19.1 % versus 47.7 % ( χ2-test , p = 0.003 ) . The grade 2 GU acute toxicity-free survival was significantly better in the HFRT arm ( log-rank test , p = 0.008 ) . The median duration of overall GI acute toxicity was shorter with HFRT : 3 compared to 6 weeks with CFRT ( median test , p = 0.017 ) . Conclusion : In this first evaluation , the HFRT schedule is feasible and induces acceptable or even lower acute toxicity compared with the toxicities in the CFRT schedule . Extended follow-up is needed to justify this fractionation schedule ’s safety in the long term . Ziel : Es soll die Frage beantwortet werden , ob bei der Beh and lung des lokalisierten Adenokarzinoms der Prostata ein hypofraktioniertes Schema ( HFRT ) die gleichen Tumorkontroll- und Nebenwirkungsraten zeigt wie ein konventionelles Schema ( CFRT ) . Hier wird uber die ersten Ergebnisse zu den Nebenwirkungen berichtet . Patienten und Method ik:91 Patienten wurden i m Rahmen einer Studie r and omisiert beh and elt , die minimale Nachbeobachtungszeit lag bei 3 Monaten . I m CFRT-Arm ( 44 Patienten ) betrug die Dosis 74 Gy ( 37 × 2 Gy/d ) , i m HFRT-Arm ( 47 Patienten ) 57 Gy ( 17 × 3 Gy/d , 4 × 4,5 Gy/d ) . Das klinische Zielvolumen ( CTV ) umfasste die Prostata und Output:

In terms of efficacy , there is considerable heterogeneity among the studies , and no conclusive results were found concerning the superiority of the hypofractionated option over the normal fractionated option . In terms of safety , there were no significant differences in the onset of acute genitourinary complications between the 2 treatments . There were no significant differences in long-term complications based on the type of radiation therapy used , although the studies did have limitations . To date , there are no conclusive results that show that hypofractionated radiation therapy is more effective or safer than normal fractionated radiation therapy in the treatment of localized prostate cancer

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***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND AND AIMS To undertake the first r and omized controlled trial to evaluate the effectiveness of a brief intervention delivered by community pharmacists to reduce hazardous or harmful drinking . DESIGN This parallel group r and omized trial allocated participants individually to brief alcohol intervention ( n = 205 ) or a leaflet-only control condition ( n = 202 ) , with follow-up study after 3 months . SETTING Sixteen community pharmacies in one London Borough , UK . PARTICIPANTS A total of 407 pharmacy customers ( aged 18 years or over ) with Alcohol Use Disorder Identification Test ( AUDIT ) scores 8 - 19 , inclusive . INTERVENTION A brief motivational discussion of approximately 10 minutes ' duration , for which 17 pharmacists received a half-day of training . MEASUREMENTS Hazardous or harmful drinking was assessed using the AUDIT administered by telephone by a research er blind to allocation status . The two primary outcomes were : ( 1 ) change in AUDIT total scores and ( 2 ) the proportions no longer hazardous or harmful drinkers ( scoring < 8) at 3 months . The four secondary outcomes were : the three subscale scores of the AUDIT ( for consumption , problems and dependence ) and health status according to the EQ-5D ( a st and ardized instrument for use as a measure of health outcome ) . FINDINGS At 3 months 326 ( 80 % overall ; 82 % intervention , 78 % control ) participants were followed-up . The difference in reduction in total AUDIT score ( intervention minus control ) was -0.57 , 95 % confidence interval ( CI ) = -1.59 to 0.45 , P = 0.28 . The odds ratio for AUDIT ˂ 8 ( control as reference ) was 0.87 , 95 % CI = 0.50 to 1.51 , P = 0.61 ) . For two of the four secondary outcomes ( dependence score : -0.46 , 95 % CI = -0.82 to -0.09 , P = 0.014 ; health status score : -0.09 , 95 % CI = -0.16 to -0.02 , P = 0.013 ) the control group did better , and in the other two there were no differences ( consumption score : -0.05 , 95 % CI = -0.54 to 0.44 , P = 0.85 ; non-dependence problems score : -0.13 , 95 % CI = -0.66 to 0.41 ) . Sensitivity analyses did not change these findings . CONCLUSIONS A brief intervention delivered by community pharmacists appears to have had no effect in reducing hazardous or harmful alcohol consumption OBJECTIVE To evaluate a training workshop for community pharmacy personnel to improve their counselling in smoking cessation based on the stage-of-change model . DESIGN A r and omised controlled trial of community pharmacies and pharmacy customers . SETTING All 76 non-city community pharmacies registered in Grampian , Scotl and , were invited to participate . Sixty-two pharmacies ( 82 % ) were recruited . SUBJECTS All the intervention pharmacy personnel were invited to attend the training ; 40 pharmacists and 54 assistants attended . A total of 492 customers who smoked ( 224 intervention , 268 controls ) were recruited during the 12-month recruitment period ( overall recruitment rate 63 % ) . MAIN OUTCOME MEASURES The perceptions of customers and pharmacy personnel of the pharmacy support and self-reported smoking cessation rates for the two groups of customers at one , four , and nine months . RESULTS The intervention customer respondents were significantly more likely to have discussed stopping smoking with pharmacy personnel , 85 % ( 113 ) compared with 62 % ( 99 ) of the controls ( p<0.001 ) . The former also rated their discussion more highly ; 34 % ( 45 ) of the intervention customers compared with 16 % ( 25 ) of the controls rated it as “ very useful ” ( p = 0.048 ) . Assuming non-responders had lapsed , one-month point prevalence of abstinence was cl aim ed by 30 % of intervention customers and 24 % of controls ( p = 0.12 ) ; four months ’ continuous abstinence was cl aim ed by 16 % of intervention customers and 11 % of controls ( p = 0.094 ) ; and nine months ’ continuous abstinence was cl aim ed by 12 % of intervention customers and 7 % of controls ( p = 0.089 ) . These trends in outcome were not affected by potential confounders ( sex , age , socioeconomic status , nicotine dependence , and type of nicotine replacement product used ) or adjustment for clustering . CONCLUSIONS The intervention was associated with increased and more highly rated counselling , and a trend toward higher smoking cessation rates , indicating that community pharmacy personnel have the potential to make a significant contribution to national smoking cessation targets Background Tobacco smoking leads to death or disability and a drain on national re sources . The literature suggests that cigarette smoking continues to be a major modifiable risk factor for a variety of diseases and that smokers aged 18 - 30 years are relatively resistant to antismoking messages due to their widely held belief that they will not be lifelong smokers . Objective To conduct a r and omized controlled trial ( RCT ) of a computer-generated photoaging intervention to promote smoking cessation among young adult smokers within a community pharmacy setting . Methods A trial was design ed with 80 % power based on the effect size observed in a published pilot study ; 160 subjects were recruited ( 80 allocated to the control group and 80 to the intervention group ) from 8 metropolitan community pharmacies located around Perth city center in Western Australia . All participants received st and ardized smoking cessation advice . The intervention group participants were also digitally photoaged by using the Internet-based APRIL Face Aging software so they could p review images of themselves as a lifelong smoker and as a nonsmoker . Due to the nature of the intervention , the participants and research er could not be blinded to the study . The main outcome measure was quit attempts at 6-month follow-up , both self-reported and biochemically vali date d through testing for carbon monoxide ( CO ) , and nicotine dependence assessed via the Fagerström scale . Results At 6-month follow-up , 5 of 80 control group participants ( 6.3 % ) suggested they had quit smoking , but only 1 of 80 control group participants ( 1.3 % ) consented to , and was confirmed by , CO validation . In the intervention group , 22 of 80 participants ( 27.5 % ) reported quitting , with 11 of 80 participants ( 13.8 % ) confirmed by CO testing . This difference in biochemically confirmed quit attempts was statistically significant ( χ2 1=9.0 , P=.003 ) . A repeated measures analysis suggested the average intervention group smoking dependence score had also significantly dropped compared to control participants ( P<.001 ) . These differences remained statistically significant after adjustment for small differences in gender distribution and nicotine dependence between the groups . The mean cost of implementing the intervention was estimated at AU $ 5.79 per participant . The incremental cost-effectiveness ratio was AU $ 46 per additional quitter . The mean cost that participants indicated they were willing to pay for the digital aging service was AU $ 20.25 ( SD 15.32 ) . Conclusions Demonstrating the detrimental effects on facial physical appearance by using a computer-generated simulation may be both effective and cost-effective at persuading young adult smokers to quit . Trial Registration Australian New Zeal and Clinical Trials Registry : ACTRN12609000885291 ; https://www.anzctr.org.au/Trial/ Registration /Trial Review .aspx?ACTRN=12609000885291 ( Archived by WebCite at http://www.webcitation.org/6F2kMt3kC OBJECTIVE To compare a meal replacement ( MR ) program with a conventional reduced-calorie diet ( RCD ) for weight management using the pharmacy as the setting and the pharmacist as the point of contact for dietary advice . DESIGN R and omized , controlled , open-label trial . SETTING Travis Pharmacy in Shen and oah , Iowa . PATIENTS Ninety-five patients from southwestern iowa and southeastern Nebraska were enrolled , of whom 88 were considered eligible for comparison ( by continuing through week 2 of the study ) . INTERVENTION Patients were r and omized to an MR plan or a traditional RCD plan . Patients were followed for a 3-month period of active weight loss and a 10-week period of weight maintenance . Patients returned every 3 weeks for follow-up with the pharmacist , for a total of 13 visits . MAIN OUTCOME MEASURE Weight changes . RESULTS During the active weight loss phase , the MR ( n = 45 ) and RCD ( n = 43 ) groups lost a significant amount of weight , although no significant difference was found between the groups ( mean + /- st and ard error = 4.90 + /- 0.30 kg MR versus 4.30 + /- 0.30 kg RCD ; P = .16 ) . In the weight maintenance phase , the MR group lost 0.70 + /- 0.40 kg and the RCD group lost 0.90 + /- 0.40 kg ( P = .60 ) . Significant improvements were observed in waist circumference , systolic and diastolic blood pressure , and triglyceride levels . No significant changes were seen in high-density lipoprotein cholesterol or low-density lipoprotein cholesterol levels in either group . CONCLUSION Successful weight management can be achieved in a pharmacy setting . Both MR and RCD programs were effective We conducted a r and omized , controlled study to evaluate whether pharmacists ' advice on smoking cessation would result in a higher smoking cessation rate using Nicorette ( nicotine gum preparation ) . Fourteen pharmacies in Tokyo , Kanagawa , and Nagano participated . Smokers who visited pharmacies to buy Nicorette from March 1 , 2002 , through August 31 , 2002 , were recruited and r and omly assigned to two groups . For the intervention group ( A ) , pharmacists provided both regular instructions on Nicorette use and smoking cessation advice at the first sale and then gave follow-up advice just before starting a cessation and 1 , 3 , and 8 weeks and 3 months thereafter . For the control group ( B ) , pharmacists provided regular instructions alone . The primary outcome measure was the self-reported smoking cessation rate and the secondary outcome measure was the relationship between the smoker 's egogram and effectiveness of intervention . Twenty-eight smokers were enrolled and r and omized into group A ( n=11 ) or group B ( n=17 ) . The absolute abstinence rate in groups A and B at 3 months was 45.5 % and 31.2 % , respectively . The odds ratio was 1.83 , which was not statistically significant . There was no difference in egogram score between absolute abstinence subjects and nonabstinence subjects in group A. The egogram scores in Adapted Child of absolute abstinence subjects in group B were significantly higher than in nonabstinence subjects . In conclusion , instructions and advice given by pharmacists may improve the smoking cessation rate in smokers receiving nicotine replacement therapy Background Community pharmacists can deliver health care advice at an opportunistic level , related to prescription or non-prescription medicines and as part of focused services design ed to reduce specific risks to health . Obesity , smoking and excessive alcohol intake are three of the most significant modifiable risk factors for morbidity and mortality in the UK , and interventions led by community pharmacists , aim ed at these three risk factors , have been identified by the government as public health priorities . In 2008 , the Department of Health for Engl and stated that ‘ a sound evidence base that demonstrates how pharmacy delivers effective , high quality and value for money services is needed ’ ; this systematic review aims to respond to this requirement . Methods / design We will search the data bases MEDLINE , Embase , CINAHL , PsycINFO , Social Sciences Citation Index , ASSIA , IBSS , Sociological Abstract s , Scopus and NHS Economic Evaluation Data base for studies that have evaluated interventions based on community pharmacies that aim to target weight management , smoking cessation and alcohol misuse . We will include all r and omised controlled trials ( RCTs ) , non-r and omised controlled trials ( N RCTs ) , controlled before-after studies ( CBAs ) and interrupted time series ( ITS ) and repeated measures studies . Data from included studies will be extracted by two independent review ers and will include study details methods , results , intervention implementation/costs and method ological quality . Meta- analysis will be conducted if appropriate ; if not , the synthesis will be restricted to a narrative overview of individual studies looking at the same question . Discussion The review aims to summarise the evidence base on the effectiveness of community pharmacy interventions on health and health behaviours in relation to weight management , smoking cessation and alcohol misuse . It will also explore if , and how , socio-economic status , gender , ethnicity and age moderate the effect of the interventions and will describe how the interventions included in the review have been organised , implemented and delivered , since context is an important factor governing the success of public health interventions . The findings from this review will have an impact on the commissioning of public health services aim ing to promote healthy weight , smoking cessation and prevent excessive alcohol consumption . Systematic review registration The review has been registered with PROSPERO ( registration no. Output:

Pharmacy-based interventions produced similar weight loss compared with active interventions in other primary care setting s ; however , weight loss was not sustained longer term in a range of primary care and commercial setting s compared with control . Pharmacy-based weight management interventions have similar provider costs to those delivered in other primary care setting s , which are greater than those delivered by commercial organisations . Very few studies explored if and how sociodemographic or socioeconomic variables moderated intervention effects . Insufficient information was available to examine relationships between effectiveness and behaviour change strategies , implementation factors , or organisation and delivery of interventions . Community pharmacy-delivered interventions are effective for smoking cessation , and demonstrate that the pharmacy is a feasible option for weight management interventions .

MS2_1shot473

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND AIMS Stem cell therapy ( SCT ) is now the up-coming therapeutic modality for treatment of type 1 diabetes mellitus ( T1DM ) . METHODS Our study was a prospect i ve , open-labeled , two-armed trial for 10 T1DM patients in each arm of allogenic and autologous adipose-derived insulin-secreting mesenchymal stromal cells (IS-AD-MSC)+bone marrow-derived hematopoietic stem cell ( BM-HSC ) infusion . Group 1 received autologous SCT : nine male patients and one female patient ; mean age , 20.2 years , disease duration 8.1 years ; group 2 received allogenic SCT : six male patients and four female patients , mean age , 19.7 years and disease duration , 7.9 years . Glycosylated hemoglobin ( HbA1c ) was 10.99 % ; serum ( S. ) C-peptide , 0.22 ng/mL and insulin requirement , 63.9 IU/day in group 1 ; HbA1c was 11.93 % , S.C-peptide , 0.028 ng/mL and insulin requirement , 57.55 IU/day in group 2 . SCs were infused into the portal+thymic circulation and subcutaneous tissue under non-myelo-ablative conditioning . Patients were monitored for blood sugar , S.C-peptide , glutamic acid decarboxylase antibodies and HbA1c at 3-month intervals . RESULTS Group 1 received mean SCs 103.14 mL with 2.65 ± 0.8 × 10(4 ) ISCs/kg body wt , CD34 + 0.81 % and CD45-/90+/73 + , 81.55 % . Group 2 received mean SCs 95.33 mL with 2.07 ± 0.67 × 10(4 ) ISCs/kg body wt , CD34 + 0.32 % and CD45-/90+/73 + 54.04 % . No untoward effect was observed with sustained improvement in HbA1c and S.C-peptide in both groups with a decrease in glutamic acid decarboxylase antibodies and reduction in mean insulin requirement . CONCLUSIONS SCT is a safe and viable treatment option for T1DM . Autologous IS-AD-MSC+ BM-HSC co-infusion offers better long-term control of hyperglycemia as compared with allogenic SCT CONTEXT Type 1 diabetes mellitus ( DM ) results from a cell-mediated autoimmune attack against pancreatic beta cells . Previous animal and clinical studies suggest that moderate immunosuppression in newly diagnosed type 1 DM can prevent further loss of insulin production and can reduce insulin needs . OBJECTIVE To determine the safety and metabolic effects of high-dose immunosuppression followed by autologous nonmyeloablative hematopoietic stem cell transplantation ( AHST ) in newly diagnosed type 1 DM . DESIGN , SETTING , AND PARTICIPANTS A prospect i ve phase 1/2 study of 15 patients with type 1 DM ( aged 14 - 31 years ) diagnosed within the previous 6 weeks by clinical findings and hyperglycemia and confirmed with positive antibodies against glutamic acid decarboxylase . Enrollment was November 2003-July 2006 with observation until February 2007 at the Bone Marrow Transplantation Unit of the School of Medicine of Ribeirão Preto , Ribeirão Preto , Brazil . Patients with previous diabetic ketoacidosis were excluded after the first patient with diabetic ketoacidosis failed to benefit from AHST . Hematopoietic stem cells were mobilized with cyclophosphamide ( 2.0 g/m2 ) and granulocyte colony-stimulating factor ( 10 microg/kg per day ) and then collected from peripheral blood by leukapheresis and cryopreserved . The cells were injected intravenously after conditioning with cyclophosphamide ( 200 mg/kg ) and rabbit antithymocyte globulin ( 4.5 mg/kg ) . MAIN OUTCOME MEASURES Morbidity and mortality from transplantation and temporal changes in exogenous insulin requirements ( daily dose and duration of usage ) . Secondary end points : serum levels of hemoglobin A1c , C-peptide levels during the mixed-meal tolerance test , and anti-glutamic acid decarboxylase antibody titers measured before and at different times following AHST . RESULTS During a 7- to 36-month follow-up ( mean 18.8 ) , 14 patients became insulin-free ( 1 for 35 months , 4 for at least 21 months , 7 for at least 6 months ; and 2 with late response were insulin-free for 1 and 5 months , respectively ) . Among those , 1 patient resumed insulin use 1 year after AHST . At 6 months after AHST , mean total area under the C-peptide response curve was significantly greater than the pretreatment values , and at 12 and 24 months it did not change . Anti-glutamic acid decarboxylase antibody levels decreased after 6 months and stabilized at 12 and 24 months . Serum levels of hemoglobin A(1c ) were maintained at less than 7 % in 13 of 14 patients . The only acute severe adverse effect was culture-negative bilateral pneumonia in 1 patient and late endocrine dysfunction ( hypothyroidism or hypogonadism ) in 2 others . There was no mortality . CONCLUSIONS High-dose immunosuppression and AHST were performed with acceptable toxicity in a small number of patients with newly diagnosed type 1 DM . With AHST , beta cell function was increased in all but 1 patient and induced prolonged insulin independence in the majority of the patients OBJECTIVE To determine if autologous nonmyeloablative hematopoietic stem cell transplantation ( AHSCT ) was beneficial for type 1 diabetic adolescents with diabetic ketoacidosis ( DKA ) at diagnosis . RESEARCH DESIGN AND METHODS We enrolled 28 patients with type 1 diabetes , aged 14–30 years , in a prospect i ve AHSCT phase II clinical trial . HSCs were harvested from the peripheral blood after pretreatment consisting of a combination of cyclophosphamide and antithymocyte globulin . Changes in the exogenous insulin requirement were observed and serum levels of HbA1c , C-peptide , and anti-glutamic acid decarboxylase antibody were measured before and after the AHSCT . RESULTS After transplantation , complete remission ( CR ) , defined as insulin independence , was observed in 15 of 28 patients ( 53.6 % ) over a mean period of 19.3 months during a follow-up ranging from 4 to 42 months . The non-DKA patients achieved a greater CR rate than the DKA patients ( 70.6 % in non-DKA vs. 27.3 % in DKA , P = 0.051 ) . In the non-DKA group , the levels of fasting C-peptide , peak value during oral glucose tolerance test ( Cmax ) , and area under C-peptide release curve during oral glucose tolerance test were enhanced significantly 1 month after transplantation and remained high during the 24-month follow-up ( all P < 0.05 ) . In the DKA group , significant elevation of fasting C-peptide levels and Cmax levels was observed only at 18 and 6 months , respectively . There was no mortality . CONCLUSIONS We have performed AHSCT in 28 patients with type 1 diabetes . The data show AHSCT to be an effective long-term treatment for insulin dependence that achieved a greater efficacy in patients without DKA at diagnosis There is a growing interest in cell-based therapies in T2DM as β-cell failure is progressive and inexorable with the advancing duration of disease . This prospect i ve , r and omized , single-blinded placebo-controlled study evaluates the efficacy and safety of autologous bone marrow-derived stem cell transplantation ( ABMSCT ) in T2DM . Twenty-one patients with triple oral antidiabetic drug failure and requiring insulin ≥0.4 IU per kg per day with HbA1c < 7.5 % were r and omly assigned to an intervention ( n = 11 ) and control group ( n = 10 ) and followed for 12 months . Patients in the intervention group received ABMSCT through a targeted approach , and after 12 weeks , a second dose of stem cells was administered through the antecubital vein after mobilization with G-CSF , while the control group underwent a sham procedure . The primary end point was a reduction in insulin requirement by ≥50 % from baseline while maintaining HbA1c < 7 % . Nine out of the 11 ( 82 % ) patients in the intervention group achieved the primary end point , whereas none of the patients in the control group did over the study period ( p = 0.002 ) . The insulin requirement decreased by 66.7 % in the intervention group from 42.0 ( 31.0 - 64.0 ) IU per day to 14.0 ( 0.0 - 30.0 ) IU per day ( p = 0.011 ) , while in controls it decreased by 32.1 % from 40.5 ( 31.8 - 44.3 ) IU per day to 27.5 ( 23.5 - 33.3 ) IU per day ( p = 0.008 ) at 12 months . The reduction in insulin requirement was significantly more in the intervention group compared to controls at both 6 ( p = 0.001 ) and 12 months ( p = 0.004 ) . There was a modest but nonsignificant increase in HbA1c ( % ) in cases from 6.9 % ( 6.4 - 7.2 % ) to 7.1 % ( 6.6 - 7.5 % ) as well as in controls from 6.9 % ( 6.2 - 7.0 % ) to 7.0 % ( 6.9 - 7.5 % ) . Ten out of 11 ( 91 % ) patients could maintain HbA1c < 7 % in the intervention group , whereas 6 out of 10 did ( 60 % ) in the control group ( p = 0.167 ) . The glucagon-stimulated C-peptide significantly increased in treated cases compared to controls ( p = 0.036 ) . The decrease in insulin requirement positively correlated with stimulated C-peptide ( r = 0.8 , p = 0.001 ) . In conclusion , ABMSCT results in a significant decrease in the insulin dose requirement along with an improvement in the stimulated C-peptide levels in T2DM . However , a greater number of patients with a longer duration of follow-up are required to substantiate these observations Introduction Stem cell therapy has recently been introduced to treat patients with type 2 diabetes mellitus ( T2DM ) . However , no data are available on the efficacy and safety of allogeneic Wharton ’s Jelly-derived mesenchymal stem cell ( WJ-MSC ) transplantation in patients with T2DM . Here we performed a non-placebo controlled prospect i ve phase I/II study to determine efficacy and safety of WJ-MSC transplantation in T2DM . Methods Twenty-two patients with T2DM were enrolled and received WJ-MSC transplantation through one intravenous injection and one intrapancreatic endovascular injection ( catheterization ) . They were followed up for 12 months after transplantation . The primary endpoints were changes in the levels of glycated hemoglobin and C-peptide and the secondary endpoints included insulin dosage , fasting blood glucose ( FBG ) , post-meal blood glucose ( PBG ) , inflammatory markers and T lymphocyte counts . Results WJ-MSC transplantation significantly decreased the levels of glucose and glycated hemoglobin , improved C-peptide levels and beta cell function , and reduced markers of systemic inflammation and T lymphocyte counts . No major WJ-MSC transplantation-related adverse events occurred , but data suggest a temporary decrease in levels of C-peptide and beta cell function at one month after treatment , possibly related to intrapancreatic endovascular injection . Conclusions Our data demonstrate that treatment with WJ-MSCs can improve metabolic control and beta cell function in patients with T2DM . The therapeutic mechanism may involve improvements in systemic inflammation and /or immunological regulation . Trial registration Chinese Clinical Trial Register ChiCTR-ONC-10000985 . Registered 23 September Drugs targeting β-cells have provided new options in the management of T2DM ; however , their role in β-cell regeneration remains elusive . The recent emergence of cell-based therapies such as autologous bone marrow-derived mesenchymal stem cells ( ABM-MSCs ) and mononuclear cells ( ABM-MNCs ) seems to offer a pragmatic approach to augment β-cell function/mass . This study aims to examine the efficacy and safety of ABM-MSC and ABM-MNC transplantation in T2DM and explores alterations in glucose-insulin homeostasis by metabolic studies . Thirty patients of T Output:

Subgroup analyses showed significant HbA1c and C-peptide improvements in patients with T1DM treated with bone marrow hematopoietic stem cells ( BM-HSCs ) , while there was no significant change in the mesenchymal stem cell ( MSC ) group . In T2DM , HbA1c and insulin requirements decreased significantly after MSC transplantation , and insulin requirements and C-peptide levels were significantly improved after bone marrow mononuclear cell ( BM-MNC ) treatment . Stem cell therapy is a relatively safe and effective method for selected individuals with DM . The data showed that BM-HSCs are superior to MSCs in the treatment of T1DM . In T2DM , MSC and BM-MNC transplantation showed favorable therapeutic effects

MS2_1shot474

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Background The incidence of shoulder pain ( SP ) following laparoscopic cholecystectomy ( LC ) varies between 21 and 80 % . A few r and omised controlled trials and meta- analysis have shown lesser SP in LC performed under low-pressure carbon dioxide pneumoperitoneum ( LPCP ) than under st and ard-pressure carbon dioxide pneumoperitoneum ( SPCP ) . However , the possible compromise in adequate exposure and effective working space during LPCP has negatively influenced its uniform adoption for LC . Material s and methods All consecutive patients undergoing elective LC for gallstone disease who met the inclusion and exclusion criteria were enroled . Fourty patients were r and omised to SPCP group ( pressure of 14 mmHg ) and 40 to LPCP group ( pressure of 9–10 mmHg ) . Primary outcome measured was incidence of SP and its severity on visual analogue scale ( VAS ) at 4 , 8 , 24 h and 7 days after LC . Secondary outcomes measured were procedural time , technical difficulty , surgeons ’ satisfaction score on exposure and working space , intra-operative changes in heart rate and blood pressure , abdominal pain and analgesic requirement . Analyses were performed using Stata software . Results There was no conversion to open surgery , bile duct injury or need to increase intra-abdominal pressure on either group . Twenty-three patients ( 57.5 % ) in SPCP group and nine patients ( 22.5 % ) in LPCP group had SP ( p = 0.001 ) . The severity of SP was significantly more in SPCP group at 8 and 24 h ( p = 0.009 and 0.005 , respectively ) . Both the groups had similar procedural time , surgeons ’ satisfaction score , intra-operative changes in heart rate and blood pressure . Conclusion The incidence and severity of SP following LC performed at LPCP are significantly less compared to that in SPCP . The safety , efficacy and surgeons ’ satisfaction appear to be comparable in both the groups . Hence , a routine practice of low-pressure carbon dioxide pneumoperitoneum may be recommended in selected group of patients undergoing laparoscopic cholecystectomy . Clinical trial registration numbe rCT RI/2016/02/006590 Background Post-laparoscopic pain syndrome is well recognized and characterized by abdominal and particularly shoulder tip pain ; it occurs frequently following laparoscopic cholecystectomy . The etiology of post-laparoscopic pain can be classified into three aspects : visceral , incision , and shoulder . The origin of shoulder pain is only partly understood , but it is commonly assumed that the cause is overstretching of the diaphragmatic muscle fibers owing to a high rate of insufflations . This study aim ed to compare the frequency and intensity of shoulder tip pain between low-pressure ( 7 mmHg ) and st and ard-pressure ( 14 mmHg ) in a prospect i ve r and omized clinical trial . Methods One hundred and forty consecutive patients undergoing elective laparoscopic cholecystectomy were r and omized prospect ively to either high- or low-pressure pneumoperitoneum and blinded by research nurses who assessed the patients during the postoperative period . The statistical analysis included sex , mean age , weight , American Society of Anesthesiologists ( ASA ) grade , operative time , complication rate , duration of surgery , conversion rate , postoperative pain by using visual analogue scale , number of analgesic injections , incidence and severity of shoulder tip pain , and postoperative hospital stay . p < 0.05 was considered indicative of significance . Results The characteristics of the patients were similar in the two groups except for the predominance of males in the st and ard-pressure group ( controls ) . The procedure was successful in 68 of 70 patients in the low-pressure group compared with in 70 patients in the st and ard group . Operative time , number of analgesic injections , visual analogue score , and length of postoperative days were similar in both groups . Incidence of shoulder tip pain was higher in the st and ard-pressure group , but not statistically significantly so ( 27.9 % versus 44.3 % ) ( p = 0.100 ) . Conclusions Low-pressure pneumoperitoneum tended to be better than st and ard-pressure pneumoperitoneum in terms of lower incidence of shoulder tip pain , but this difference did not reach statistical significance following elective laparoscopic cholecystectomy Laparoscopy using carbon dioxide insufflation induces adverse effects in both the cardiovascular and the respiratory function . The use of low pressure pneumoperitoneum has been shown to reduce adverse hemodynamic effects . However , its effect on tissue trauma and postoperative pain and recovery remains controversial . The aim of this study was to compare tissue trauma , postoperative pain , and recovery in two groups of patients undergoing laparoscopic cholecystectomy , one at insufflation pressure of 8 ( LC8 ) and the other at 15 mm Hg ( LC15 ) . Forty patients were r and omized , 20 in each group . The characteristics of the patients were similar in the two groups . The procedure was completed in all patients in the LC15 group , but in 2 patients in the LC8 group the pressure was increased to 15 mm Hg to complete the operation . There were no significant differences in postoperative pain scores , analgesic consumption , and the incidence of nausea , vomiting , and shoulder pain between the two groups . C-reactive protein concentrations and white blood cell count rose significantly after surgery , but the increase was similar in the two groups . The median duration of surgery was similar , 23 minutes ( range 15–65 ) in the LC8 group and 25 minutes ( range 15–80 ) in the LC15 group . Using our technique of laparoscopic cholecystectomy , there were no advantages to tissue damage , postoperative pain , and recovery when a low pressure pneumoperitoneum was used BACKGROUND Abdominal pain and shoulder tip pain after laparoscopic cholecystectomy are distressing for the patient . Various causes of this pain are peritoneal stretching and diaphragmatic irritation by high intra-abdominal pressure caused by pneumoperitoneum . We design ed a study to compare the post operative pain after laparoscopic cholecystectomy at low pressure ( 7 - 8 mm of Hg ) and st and ard pressure technique ( 12 - 14 mm of Hg ) . Aim : To compare the effect of low pressure and st and ard pressure pneumoperitoneum in post laparoscopic cholecystectomy pain . Further to study the safety of low pressure pneumoperitoneum in laparoscopic cholecystectomy . SETTING S AND DESIGN A prospect i ve r and omised double blind study . MATERIAL S AND METHODS A prospect i ve r and omised double blind study was done in 100 ASA grade I & II patients . They were divided into two groups -50 each . Group A patients underwent laparoscopic cholecystectomy with low pressure pneumoperitoneum ( 7 - 8 mm Hg ) while group B underwent laparoscopic cholecystectomy with st and ard pressure pneumoperitoneum ( 12 - 13 mm Hg ) . Both the groups were compared for pain intensity , analgesic requirement and complications . STATISTICAL ANALYSIS Demographic data and intraoperative complications were analysed using chi-square test . Frequency of pain , intensity of pain and analgesics consumption was compared by applying ANOVA test . RESULTS Post-operative pain score was significantly less in low pressure group as compared to st and ard pressure group . Number of patients requiring rescue analgesic doses was more in st and ard pressure group . This was statistically significant . Also total analgesic consumption was more in st and ard pressure group . There was no difference in intraoperative complications . CONCLUSION This study demonstrates the use of simple expedient of reducing the pressure of pneumoperitoneum to 8 mm results in reduction in both intensity and frequency of post-operative pain and hence early recovery and better outcome .This study also shows that low pressure technique is safe with comparable rate of intraoperative complications Postoperative shoulder‐tip pain occurs frequently following laparoscopic cholecystectomy . The aim of this r and omized clinical trial was to evaluate the efficacy of a low‐pressure carbon dioxide pneumoperitoneum during laparoscopic surgery in reducing the incidence of postoperative shoulder‐tip pain BACKGROUND Laparoscopic cholecystectomy ( LC ) has become the st and ard treatment for gall bladder disease . However , despite its low degree of invasiveness , many patients complain of postoperative pain and postoperative nausea/vomiting . This study was planned to evaluate different factors affecting the incidence and severity of postoperative shoulder-tip pain after LC . PATIENTS AND METHODS One hundred consecutive patients who were treated for gall bladder stone by LC at the Gastroenterology Surgical Center , Mansoura University , Mansoura , Egypt , during the period from October 2008 to January 2010 , were r and omized according to different pnemoperitonum pressures ( 8 , 10 , 12 , and 14 mm Hg ) . Each group comprises 25 patients . RESULTS There were 62 patients reported to have postoperative shoulder-tip pain during the first 12 hours after operation , which decreased to 9 patients on the 10th postoperative day . A significant difference was observed in the prevalence of pain at different pressures , 11 % with low pressure and increased to 20 % with high pressure . The incidence of shoulder-tip pain was significantly more in patients with a longer duration of the operation of > 45 minutes at 12 hours ( 23 [ 76.7 % ] versus 39 [ 55.7 % ] ; P = 0.04 ) , at 24 hours ( 23 [ 76.7 % ] versus 29 [ 41.4 % ] ; P = 0.009 ) , and at 3 days postoperatively ( 19 [ 63.3 % ] versus 20 [ 28.6 % ] ; P = 0.01 ) . The volume of used gases during the operation had no effect on the incidence or severity of shoulder-tip pain after LC . Also , the use of intraoperative analgesics had no effect on the incidence or severity of shoulder-tip pain after LC . CONCLUSIONS The origin of pain after LC is multifactorial . We recommend the use of the lower pressure technique during LC , and as patients with and without drains have similar incidence of postoperative shoulder pain , drains should not be used with the intention of preventing shoulder pain Abstract Background : Peritoneal insufflation to 15 mmHg diminishes venous return and reduces cardiac output . Such changes may be dangerous in patients with a poor cardiac reserve . The aim of this study was to investigate the hemodynamic effects of high ( 15 mmHg ) and low ( 7 mmHg ) intraabdominal pressure during laparoscopic cholestectomy ( LC ) Methods : Twenty patients were r and omized to either high- or low-pressure capnoperitoneum . Anesthesia was st and ardized , and the end-tidal CO2 was maintained at 4.5 kPa . Arterial blood pressure was measured invasively . Heart rate , stroke volume , and cardiac output were measured by transesophageal doppler . Results : There were 10 patients in each group . In the high-pressure group , heart rate ( HR ) and mean arterial blood pressure ( MABP ) increased during insufflation . Stroke volume ( SV ) and cardiac output were depressed by a maximum of 26 % and 28 % ( SV 0.1 > p > 0.05 , cardiac output p > 0.1 ) . In the low-pressure group , insufflation produced a rise in MABP and a peak rise in both stroke volume and cardiac output of 10 % and 28 % , respectively ( p < 0.05 ) . Conclusions : Low-pressure pneumoperitoneum is feasible for LC and minimizes the adverse hemodynamic effects of peritoneal insufflation Introduction Intraabdominal CO2 gas after laparoscopic cholecystectomy causes postoperative shoulder-tip pain . Many methods of analgesia have been used to reduce this pain , including analgesic drugs , intraperitoneal local anesthetic , intraperitoneal saline , a gas drain , heated gas , low-pressure gas , and nitrous oxide pneumoperitoneum . The aim of this study was to evaluate the efficacy of combined low-pressure CO2 pneumoperitoneum and intraperitoneal infusion of normal saline in reducing the incidence of postoperative shoulder-tip pain . Methods Altogether , 109 patients undergoing elective laparoscopic cholecystectomy were r and omized prospect ively into three groups . Patients in group A ( n = 34 ) underwent laparoscopic cholecystectomy with 14 mmHg CO2 pneumoperitoneum ; patients in group B ( n = 37 ) underwent laparoscopic cholecystectomy with 10 mmHg CO2 pneumoperitoneum ; and those in group C ( n = 38 ) underwent laparoscopic cholecystectomy with 10 mmHg CO2 pneumoperitoneum in addition to intraperitoneal normal saline infusion in the right hemidiaphragmatic area . Shoulder-tip pain was recorded on a verbal rating scale 2 , 6 , 12 , 24 , and 48 hours after operation . Results Twelve patients in group A ( 35.2 percent ) , six in group B ( 16.2 percent ) , and seven in group C ( 18.4 percent ) complained of shoulder-tip pain . Hence , there was a significant decrease in the frequency of shoulder-tip pain in groups Output:

High IAP was not associated with a significant difference for these outcomes when compared with st and ard or low IAP . No significant differences were found between the IAP levels regarding need for conversion to open surgery ; post-operative acute bleeding , pain at 72 h , nausea , and vomiting ; and duration of surgery . Our study of published trials indicates that using low , as opposed to st and ard , IAP during laparoscopic cholecystectomy may reduce patients ’ post-operative pain , including shoulder pain , and length of hospital stay .

MS2_1shot475

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: INTRODUCTION Tobacco use is epidemic among persons living with HIV ( PLWH ) , and several studies have shown self-efficacy ( SE ) to be a predictor of successful cessation . This study examined sociobehavioral correlates of SE and its predictive value for successful cessation in a group of PLWH smokers . METHODS The study was conducted on combined patient data from 2 separate r and omized controlled trials of tobacco treatment for PLWH smokers . Both trials utilized the same SE scale at the same timepoints , and both had the same smoking cessation endpoint ( biochemically confirmed , 7-day , point prevalence abstinence at 3 months ) . Univariate and multivariate techniques were used to analyze the merged data set . RESULTS Baseline SE data were available for 272 subjects . The Self-Efficacy/Temptations Scale-Long Form demonstrated good internal reliability with overall and subscale Cronbach 's alpha of .77-.92 . Younger age , HIV risk other than injection drug use , recent alcohol use , and higher scores for anxiety , depression , loneliness , and nicotine dependence were all significantly correlated with lower baseline SE . Posttreatment SE was significantly predictive of successful cessation , whereas baseline SE was not . Subjects r and omized to the treatment interventions were significantly more likely to quit ( AOR = 2.99 [ 1.26 - 7.01 ] , p = .01 ) , and logistic regression suggested a possible mediating effect of posttreatment SE . CONCLUSIONS SE is tightly correlated with a number of modifiable affective and behavioral factors in PLWH smokers , and measures aim ed at increasing the SE to abstain in such individuals may enhance the effect of targeted tobacco treatment strategies OBJECTIVE To measure biopsychosocial domains related to tobacco use in persons living with HIV/AIDS ( PLWHAs ) . METHODS Cross-sectional interview study of 60 PLWHA smokers r and omly selected from an HIV clinic . RESULTS Participants averaged 14.4 cigarettes daily . Sixty-five percent were moderately or highly nicotine dependent , and most were motivated to quit . Substance use and depression were very common . Most reported that smoking helped them cope with depression , anxiety , and anger . Twenty-seven percent thought ( mistakenly ) that smoking raised their T-cell counts and /or helped fight infections . Referrals to quitlines or cessation programs were uncommon . CONCLUSIONS Smoking among PLWHAs is a challenging problem requiring targeted intervention strategies Persons living with HIV/AIDS who are current smokers are more likely to develop disease-related adverse health outcomes compared to nonsmokers with HIV/AIDS . However , the impact of smoking cessation on health outcomes such as symptom status and health-related quality of life ( HRQOL ) has not yet been assessed within this population . This study examined the effects of changes in smoking status on HIV-related symptom burden and health-related quality of life outcomes in a multiethnic , low-income population of persons living with HIV/AIDS . Patients ( n = 95 ) from a large , inner city HIV/AIDS clinic were enrolled in a smoking cessation trial providing nicotine replacement therapy , counseling , and self-help written material s. Biochemically verified smoking status , length of smoking abstinence , HIV-related symptom burden , and HRQOL were assessed approximately 3-months posttrial enrollment . A series of multiple linear regression models was performed to assess the associations between the smoking status variables and the health outcomes at follow-up while controlling for baseline levels . Length of smoking abstinence was significantly associated ( p = 0.02 ) with HIV-related symptom burden . Specifically , increasing number of consecutive days of smoking abstinence during the 3-month follow-up period was associated with lower levels of HIV-related symptom burden at the time of follow-up . However , 24-hour smoking prevalence was not significantly ( p > 0.05 ) associated with changes in either HIV-related symptom burden or HRQOL . These findings suggest that smoking cessation can significantly improve symptom burden for individuals living with HIV/AIDS . Moreover , these benefits are observable as early as 3 months after quitting and are positively correlated with the length of abstinence Objective : To evaluate the feasibility and preliminary efficacy of a Web-based tobacco treatment for persons living with HIV ( PLWH ) . Design : Prospect i ve , r and omized controlled trial . Setting : HIV-care center in the Bronx , New York . Subjects : Eligibility criteria included HIV infection , current tobacco usage , interest in quitting , and access to a computer with internet . One hundred thirty-eight subjects enrolled , and 134 completed the study . Intervention : Positively Smoke Free on the Web ( PSFW ) , an 8-session , 7-week targeted tobacco treatment program for PLWH , was compared with st and ard care ( brief advice to quit and self-help brochure ) . All subjects were offered nicotine patches . Main Outcome Measures : The main feasibility outcomes were number of sessions logged into , number of Web pages visited , number of interactive clicks , and total time logged in . The main efficacy outcome was biochemically verified , 7-day point prevalence abstinence 3 months after intervention . Results : PSFW subjects logged into a mean of 5.5 of 8 sessions and 26.2 of 41 pages . They executed a mean of 10 interactive clicks during a mean total of 59.8 minutes logged in . Most required reminder phone calls to complete the sessions . Educational level , anxiety score , and home access of the Web site were associated with Web site usage . Ten percent of the PSFW group vs. 4.3 % of controls achieved the abstinence end point . Among those who completed all 8 sessions , 17.9 % were abstinent , and among women completers , 30.8 % were abstinent . Conclusions : Web-based treatment is a feasible strategy for PLWH smokers , and preliminary findings suggest therapeutic efficacy Background : More than half of the persons living with human immunodeficiency virus ( HIV ; PLWH ) in the US smoke cigarettes , and tobacco use is responsible for considerable morbidity and mortality in this group . Little is known about the efficacy of tobacco treatment strategies in PLWH . Design : R and omized controlled trial comparing Positively Smoke Free ( PSF ) , an intensive group-therapy intervention targeting HIV-infected smokers , to st and ard care . Methods : A cohort of 145 PLWH smokers , recruited from an HIV-care center in the Bronx , New York , were r and omized 1:1 into the PSF program or st and ard care . All were offered a 3-month supply of nicotine replacement therapy . PSF is an 8-session program tailored to address the needs and concerns of HIV-infected smokers . The sessions were cofacilitated by a graduate student and an HIV-infected peer . The primary outcome was biochemically confirmed , 7-day point-prevalence abstinence at 3 months . Results : In the intention-to-treat analysis , PSF condition subjects had nearly double the quit rate of controls ( 19.2 % vs. 9.7 % , P = 0.11 ) . In the complete case , as-treated analysis , assignment to PSF was associated with increased odds of quitting ( odds ratioadj 3.55 , 95 % confidence interval 1.04 to 12.0 ) . Latino ethnicity and lower loneliness score were predictive of abstinence . The subjects in the PSF condition exhibited significant decreases in daily cigarette consumption and significant increases in self-efficacy and in motivation to quit . Attendance of ≥7 sessions was associated with higher quit rates . Conclusions : These findings suggest a positive effect of PSF on cessation rates in PLWH smokers . Loneliness and self-efficacy are influential factors in the smoking behaviors of PLWH Smoking is highly prevalent among HIV+ individuals and studies indicate that it may be associated with poor ART adherence , though the relationship is poorly understood . In addition little is known about interest in quitting among HIV+ smokers who are having adherence difficulties . We examined smoking and ART adherence among 203 HIV+ individuals enrolled in a r and omized trial of interventions to increase ART adherence . Prior analyses indicated there were no overall treatment group effects . Smoking status and motivation to quit was assessed at baseline and ART adherence was assessed at week 12 , 24 , 36 , and 48 . Longitudinal generalized estimating equation analysis that controlled for treatment group revealed that smoking status was not significantly related to adherence over time . Motivation to quit was high with 58 % intending to quit in the next 6 months and 25 % intending to quit in the next 30 days . Findings suggest that smoking is not associated with adherence among those with adherence difficulties . However it does not diminish importance of addressing both behaviors especially given HIV+ smokers substantial interest in changing smoking behavior . ResumenFumar es altamente prevalente entre las personas VIH-positivas y investigaciones indican que puede ser asociado con la baja adherencia a los medicamentos antiretrovirales aunque la relación no es muy entendible . Además se sabe poco sobre el interés en dejar de fumar entre los fumadores VIH-positivos que están teniendo dificultades de adherencia . Examinamos la relación entre el fumar y adherencia a los medicamentos antiretrovirales entre 203 personas VIH-positivas reclutadas a una investigación aleatoria de intervenciones para aumentar la adherencia antirretroviral . Los análisis previos indicaban que no había efectos globales del grupo de tratamiento . El consumo de tabaco y la motivación para dejar de fumar se evaluó al inicio de la investigación y la adherencia antirretroviral se evaluó en la semana 12 , 24 , 36 , y 48 . Análisis de la ecuación de estimación generalizada longitudinal control and o por el efecto del grupo de tratamiento mostro que el consumo de tabaco no se relacionó significativamente con la adherencia con el tiempo . La motivación para dejar de fumar fue alta con el 58 % de personas con intención de dejar de fumar en los próximos 6 meses y el 25 % con la intención de dejar de fumar en los próximos 30 días . Los result ados sugieren que el fumar no está asociado con la adherencia de medicamentos antiretrovirales entre las personas con dificultades de adherencia . Sin embargo , no disminuye la importancia de abordar ambas conductas especialmente dado el interés sustancial de cambiar el consumo de tabaco entre fumadores VIH-positivos Unhealthy substance-use behaviors , including a heavy alcohol intake , illicit drug use , and cigarette smoking , are engaged in by many HIV-positive individuals , often as a way to manage their disease-related symptoms . This study , based on data from a larger r and omized controlled trial of an HIV/AIDS symptom management manual , examines the prevalence and characteristics of unhealthy behaviors in relation to HIV/AIDS symptoms . The mean age of the sample ( n = 775 ) was 42.8 years and 38.5 % of the sample was female . The mean number of years living with HIV was 9.1 years . The specific self-reported unhealthy substance-use behaviors were the use of marijuana , cigarettes , a large amount of alcohol , and illicit drugs . A subset of individuals who identified high levels of specific symptoms also reported significantly higher substance-use behaviors , including amphetamine and injection drug use , heavy alcohol use , cigarette smoking , and marijuana use . The implication s for clinical practice include the assessment of self-care behaviors , screening for substance abuse , and education of persons regarding the self-management of HIV Background : Asymptomatic ischaemic heart disease ( IHD ) in HIV-infected patients has not been studied . Methods : Resting , 12-lead electrocardiograms ( ECG ) were evaluated for asymptomatic IHD ( Q-wave and /or ST segment depression ) at baseline from HIV-infected participants with no known IHD enrolling in the SMART study . The ECG recordings were st and ardized and central ly analysed . Factors associated with asymptomatic IHD were identified by logistic regression , sequentially adjusted for demographics , clinical history , metabolic risk factors and type and duration of antiretroviral therapy ( ART ) . Results : Of 4831 participants with an evaluable , baseline ECG and no prior IHD , mean age was 44 years ( SD , 9.3 ) ; 28.4 % were female ; 6.6 % had diabetes ; 16.5 % were receiving antihypertensive therapy ; and 95.4 % were ART experienced . ECG evidence of IHD was detected in 526 ( 10.9 % ) [ Q-wave in 283 ( 5.9 % ) , ST segment depression in 264 ( 5.5 % ) ] ; 16.7 % in those 60 years or older . Variables independently associated with these abnormalities were older age [ age ≥ 60 versus < 40 years : odds ratio ( OR ) , 2.2 ; 95 % confidence interval ( CI ) , 1.5–3.2 ; P < 0.001 ] , current antihypertensive therapy ( OR , 1.5 ; 95 % CI , 1.1–1.9 ; P = 0.003 ) and recruitment in Europe ( OR , 1.4 ; 95 % CI , 1.1–1.7 ; P = 0.0 Output:

Discussion : Unlike the general US population , there was no difference in smoking prevalence for female versus male PLWH ( both > 50 % ) indicating that HIV infection status was associated with a greater relative increase in smoking for women than men .

MS2_1shot476

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: This study aim ed to replicate findings that alcohol consumption and positive implicit beer-related cognitions can be reduced using inhibitory control ( IC ) training , with the addition of an active training control . Frontal EEG asymmetry , an objective psychophysiological index of approach motivation , was used as a dependent measure to examine training outcomes . Participants were r and omly assigned to one of two IC training conditions ( Beer NoGo or Beer Go ) or a Brief Alcohol Intervention ( BAI ) ( i.e. the active training control ) . The IC training tasks consistently paired a stimulus that required a response with images of water ( Beer NoGo ) or images of beer ( Beer Go ) . Alcohol consumption and implicit beer-related cognitions were measured at pre-training , post-training and at one week follow-up . Frontal EEG asymmetry was recorded during a passive image viewing task that presented neutral , healthy , and beer stimuli - at pre-training , post-training and follow-up . Participants in the Beer NoGo and BAI conditions consumed less beer in a taste test immediately after training than Beer Go participants , suggesting that IC training may be as effective as the already established BAI . The taste test findings were in line with the frontal EEG asymmetry data , which indicated that approach motivation for beer stimuli was altered in the expected directions . However , the positive correlation between post-training frontal EEG asymmetry data and taste test consumption was not significant . While there were no significant changes in implicit beer-related cognitions following training , a trending positive relationship between implicit beer-related cognitions at post-training and taste test consumption was reported . Further exploration addressing the limitations of the current study is required in order to clarify the implication s of these findings OBJECTIVE Alcohol screening and brief intervention ( SBI ) has gained widespread acceptance as an effective method for reducing problem drinking in at-risk population s. This study examines the cost and cost-effectiveness of an SBI pilot program delivered in an inner-city hospital emergency department ( ED ) to a traditionally underserved population . METHOD A total of 1,036 subjects were screened for problem drinking during their visit to an ED . Eligible participants ( N = 294 ) were r and omly assigned to either a brief intervention group or a control group . As the result of attrition , a final sample of 194 ( 90 brief intervention ; 104 control ) participants remained at follow-up . The intervention consisted of a brief counseling session and a health information packet . The control group received only the packet . Intervention cost data were collected and analyzed using the Drug Abuse Treatment Cost Analysis Program . Selected outcomes at the 3-month follow-up included the raw Alcohol Use Disorders Identification Test score , average weekly number of drinks and engaging in heavy drinking in the past month ( > 6 drinks on one occasion for men , > 4 for women ) . Outcome differences between the intervention and control groups were estimated with both bivariate and multivariate techniques . RESULTS The average economic cost of the brief intervention was dollars 632 per subject , of which screening ( dollars 497 ) was the largest component . In all cases , intervention subjects had better 3-month outcomes than control subjects , but the differences were not always statistically significant . Cost-effectiveness ratios were relatively small for all three outcomes , suggesting this type of intervention has the potential to be cost-effective under full implementation . CONCLUSIONS The preliminary results demonstrate the potential advantage of further research in this area with larger sample s and a longer follow-up period Background Excessive alcohol consumption has been linked to deleterious health consequences among undergraduate students . There is a need to develop theory-based and cost-effective brief interventions to attenuate alcohol consumption in this population . Purpose The present study tested the effectiveness of an integrated theory-based intervention in reducing undergraduates ' alcohol consumption in excess of guideline limits in national sample s from Estonia , Finl and , and the UK . Method A 2 ( volitional : implementation intention vs. no implementation intention ) × 2 ( motivation : mental simulation vs. no mental simulation ) × 3 ( nationality : Estonia vs. Finl and vs. UK ) r and omized-controlled design was adopted . Participants completed baseline psychological measures and self-reported number of alcohol units consumed and binge-drinking frequency followed by the intervention manipulation . One month later , participants completed follow-up measures of the psychological variables and alcohol consumption . Results Results revealed main effects for implementation intention and nationality on units of alcohol consumed at follow-up and an implementation intention × nationality interaction . Alcohol consumption was significantly reduced in the implementation intention condition for the Estonian and UK sample s. There was a significant main effect for nationality and an implementation intention × nationality interaction on binge-drinking frequency . Follow-up tests revealed significant reductions in binge-drinking occasions in the implementation intention group for the UK sample only . Conclusion Results support the implementation intention component of the intervention in reducing alcohol drinking in excess of guideline limits among Estonian and UK undergraduates . There was no support for the motivational intervention or the interaction between the strategies . Results are discussed with respect to intervention design based on motivational and volitional approaches Background Brief interventions via the internet have been shown to reduce university students ’ alcohol intake . This study tested two smartphone applications ( apps ) targeting drinking choices on party occasions , with the goal of reducing problematic alcohol intake among Swedish university students . Methods Students were recruited via e-mails sent to student union members at two universities . Those who gave informed consent , had a smartphone , and showed risky alcohol consumption according to the Alcohol Use Disorders Identification Test ( AUDIT ) were r and omized into three groups . Group 1 had access to the Swedish government alcohol monopoly ’s app , Promillekoll , offering real-time estimated blood alcohol concentration ( eBAC ) calculation ; Group 2 had access to a web-based app , PartyPlanner , developed by the research group , offering real-time eBAC calculation with planning and follow-up functions ; and Group 3 participants were controls . Follow-up was conducted at 7 weeks . Results Among 28574 students offered participation , 4823 agreed to join ; 415 were excluded due to incomplete data , and 1932 fulfilled eligibility criteria for r and omization . Attrition was 22.7–39.3 percent , higher among heavier drinkers and highest in Group 2 . Self-reported app use was higher in Group 1 ( 74 % ) compared to Group 2 ( 41 % ) . Per- protocol analyses revealed only one significant time-by-group interaction , where Group 1 participants increased the frequency of their drinking occasions compared to controls ( p = 0.001 ) . Secondary analyses by gender showed a significant difference among men in Group 1 for frequency of drinking occasions per week ( p = 0.001 ) , but not among women . Among all participants , 29 percent showed high-risk drinking , over the recommended weekly drinking levels of 9 ( women ) and 14 ( men ) st and ard glasses . Conclusions Smartphone apps can make brief interventions available to large numbers of university students . The apps studied using eBAC calculation did not , however , seem to affect alcohol consumption among university students and one app may have led to a negative effect among men . Future research should : 1 ) explore ways to increase user retention , 2 ) include apps facilitating technical manipulation for evaluation of added components , 3 ) explore the effects of adapting app content to possible gender differences , and 4 ) offer additional interventions to high-risk users . Trial registration clinical trials.gov : NCT01958398 Background Web-based tailored interventions provide users with information that is adapted to their individual characteristics and needs . R and omized controlled trials assessing the effects of tailored alcohol self-help programs among adults are scarce . Furthermore , it is a challenge to develop programs that can hold respondents ’ attention in online interventions . Objective To assess whether a 3-session , Web-based tailored intervention is effective in reducing alcohol intake in high-risk adult drinkers and to compare 2 computer-tailoring feedback strategies ( alternating vs summative ) on behavioral change , dropout , and appreciation of the program . Methods A single-blind r and omized controlled trial was conducted with an experimental group and a control group ( N=448 ) in Germany in 2010 - 2011 . Follow-up took place after 6 months . Drinking behavior , health status , motivational determinants , and demographics were assessed among participants recruited via an online access panel . The experimental group was divided into 2 subgroups . In the alternating condition ( n=132 ) , the tailored feedback was split into a series of messages discussing individual topics offered while the respondent was filling out the program . Participants in the summative condition ( n=181 ) received all advice at once after having answered all questions . The actual texts were identical for both conditions . The control group ( n=135 ) only filled in 3 question naires . To identify intervention effects , logistic and linear regression analyses were conducted among complete cases ( n=197 ) and after using multiple imputation . Results Among the complete cases ( response rate : 197/448 , 44.0 % ) who did not comply with the German national guideline for low-risk drinking at baseline , 21.1 % of respondents in the experimental group complied after 6 months compared with 5.8 % in the control group ( effect size=0.42 ; OR 2.65 , 95 % CI 1.14 - 6.16 , P=.02 ) . The experimental group decreased by 3.9 drinks per week compared to 0.4 drinks per week in the control group , but this did not reach statistical significance ( effect size=0.26 ; beta=−0.12 , 95 % CI −7.96 to 0.03 , P=.05 ) . Intention-to-treat analyses also indicated no statistically significant effect . Separate analyses of the 2 experimental subgroups showed no differences in intervention effects . The dropout rate during the first visit to the intervention website was significantly lower in the alternating condition than in the summative condition ( OR 0.23 , 95 % CI 0.08 - 0.60 , P=.003 ) . Program appreciation was comparable for the 2 experimental groups . Conclusions Complete case analyses revealed that Web-based tailored feedback can be an effective way to reduce alcohol intake among adults . However , this effect was not confirmed when applying multiple imputations . There was no indication that one of the tailoring strategies was more effective in lowering alcohol intake . Nevertheless , the lower attrition rates we found during the first visit suggest that the version of the intervention with alternating questions and advice may be preferred . Trial Registration International St and ard R and omized Controlled Trial Number ( IS RCT N ) : 91623132 ; http://www.controlled-trials.com/IS RCT N91623132 ( Archived by WebCite at http://www.webcitation.org/6J4QdhXeG ) BACKGROUND Alcoholism is a progressive neurocognitive developmental disorder . Recent evidence shows that computerized training interventions ( Cognitive Bias Modification , CBM ) can reverse some of these maladaptively changed neurocognitive processes . A first clinical study of a CBM , called alcohol-avoidance training , found that trained alcoholic patients showed less relapse at one-year follow-up than control patients . The present study tested the replication of this result , and questions about mediation and moderation . METHODS 509 alcohol-dependent patients received treatment as usual ( primarily Cognitive Behavior Therapy ) inpatient treatment . Before and after treatment , the implicit approach bias was measured with the Alcohol Approach-Avoidance Task . Half of the patients were r and omly assigned to CBM , the other half received treatment as usual only . Background variables , psychopathology and executive control were tested as possible moderating variables of CBM . One year after treatment , follow-up data about relapse were collected . RESULTS The group receiving CBM developed alcohol-avoidance behavior and reported significantly lower relapse rates at one-year follow-up . Change in alcohol-approach bias mediated this effect . Moderation analyses demonstrated that older patients and patients with a strong approach-bias at pretest profited most from CBM . CONCLUSIONS CBM is a promising treatment add-on in alcohol addiction and may counter some of the maladaptive neurocognitive effects of long-term alcoholism AIMS To test whether an expectancy challenge ( EC ) changes implicit and explicit alcohol-related cognitions and binge drinking in young heavy drinkers . This is important for theoretical and practical reasons : the EC presents a critical test for the hypothesized mediational role of alcohol cognitions and the EC has been presented as a promising intervention to counter alcohol problems in heavy drinking youth . SETTING , PARTICIPANTS AND INTERVENTION : Ninety-two heavy drinking college and university students ( half women ) were assigned r and omly to the EC or control condition ( a sham alcohol experiment in the same bar-laboratory ) . MEASUREMENTS Explicit alcohol cognitions and alcohol use were assessed with paper- and -pencil measures . Alcohol use was assessed prior to the experiment and during a 1-month follow-up . Implicit alcohol-related cognitions were assessed with two versions of the Implicit Association Test ( IAT ) , adapted to assess implicit valence and arousal associations with alcohol . FINDINGS AND CONCLUSIONS The EC result ed in decreased explicit positive arousal expectancies in men and women alike . There was some evidence for a differential reduction in implicit arousal associations , but findings depended on the version of the IAT and on the scoring-algorithm used . In men ( but not in women ) there was a short-lived differential reduction in prospect i ve alcohol use ( significant in week 3 of the follow-up ) , and this reduction was partially mediated by the decrease in explicit positive arousal expectancies . These findings suggest that an EC successfully changes explicit alcohol cognitions and that this may have short-lived beneficial effects in heavy drinking young men OBJECTIVE The current study examined the efficacy of mailed personalized normative feedback ( PNF ) as a brief alcohol intervention for at-risk college drinkers , and investigated discrepancy as a possible medi Output:

Discussion This study will establish the extent to which the five intervention modules offered in this app can help reduce hazardous and harmful drinking .

MS2_1shot477

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: There is today a wide consensus regarding the need to improve communication skills ( CS ) of health-care professionals ( HCPs ) dealing with cancer patients . Psychological training programs ( PTPs ) may be useful to acquire the needed CS . Testing the efficacy of PTP will allow to define their optimal content . The present study was design ed to assess the impact of a PTP on HCP stress , attitudes and CS , and on HCP and patients ' satisfaction with HCP communication skills in a r and omised study . A total of 115 oncology nurses were r and omly assigned to a 105-h PTP or to a waiting list . Stress was assessed with the Nursing Stress Scale , attitudes with a Semantic Differential Question naire , CS used during one simulated and one actual patient interview with the Cancer Research Campaign Workshop Evaluation Manual , and satisfaction with the nurses ' CS with a question naire completed by the patients and the nurses . Trained ( TG ) and control ( CG ) groups were compared at baseline , after 3 months ( just following training for TG ) and after 6 months ( 3 months after the end of training for TG ) . Compared to controls , trained nurses reported positive changes on their stress levels ( P⩽0.05 ) and on their attitudes ( P⩽0.05 ) . Positive training effects were found on CS used during the simulated interview : a significant increase in facilitative behaviours ( open questions : P⩽0.001 ; evaluative functions : P⩽0.05 ) and a significant decrease in inhibitory behaviours ( inappropriate information : P⩽0.01 ; false reassurance : P⩽0.05 ) . Less positive training effects were found regarding interviews with a cancer patient : a significant increase in educated guesses ( P⩽0.001 ) was noticed . No training effect was observed on nurses ' satisfaction levels , but a positive training effect was found on patients ' satisfaction levels ( P⩽0.01 ) . Although results outline PTP efficacy , they indicate the need to design PTP , amplifying the transfer of learned CS to clinical practice PURPOSE We wanted to assess the effectiveness of intensive education for physicians compared with a traditional session on communicating with breast cancer patients . METHODS A r and omized controlled trial was conducted in practice s in London , Hamilton , and Toronto , Canada , with 17 family physicians , 16 surgeons , and 18 oncologists , and with 102 patients of the surgeons and oncologists . Doctors were r and omized to 1 of 2 continuing education approaches : a traditional 2-hour version ( control group ) , or a new 6-hour intensive version including exploring the patients ’ perspectives and review ing videotapes and receiving feedback ( intervention group ) . Communication behavior of the physicians was measured objective ly both before and after the intervention . As well , 4 postintervention patient outcomes were measured , by design only for surgeons and oncologists : patient-centerdness of the visit , satisfaction , psychological distress , and feeling better . RESULTS No significant differences were found on the communication score of the intervention vs the control physicians when controlling for preintervention communication scores . Intervention family physicians , however , had significantly higher communication subscores than control family physicians . Also , patients of the intervention surgeons and oncologists were significantly more satisfied ( scores of 82.06 vs 77.78 , P = .03 ) and felt better ( 88.2 % vs 70.6 % , P=.02 ) than patients of the control surgeons and oncologists when controlling for covariates and adjusting for clustering within doctor . CONCLUSIONS The continuing medical education intervention was effective in terms of some but not all physician and patient outcomes BACKGROUND No study has yet assessed the impact of physicians ' skills acquisition after a communication skills training programme on the evolution of patients ' anxiety following a medical consultation . This study aim ed to compare the impact , on patients ' anxiety , of a basic communication skills training programme ( BT ) and the same programme consoli date d by consolidation workshops ( CW ) , and to investigate physicians ' communication variables associated with patients ' anxiety . PATIENTS AND METHODS Physicians , after attending the BT , were r and omly assigned to CW or to a waiting list . The control group was not a non-intervention group . Consultations with a cancer patient were recorded . Patients ' anxiety was assessed with the State Trait Anxiety Inventory before and after a consultation . Communication skills were analysed according to the Cancer Research Campaign Workshop Evaluation Manual . RESULTS No statistically significant change over time and between groups was observed . Mixed-effects modelling showed that a decrease in patients ' anxiety was linked with screening questions ( P = 0.045 ) , physicians ' satisfaction about support given ( P = 0.004 ) and with patients ' distress ( P < 0.001 ) . An increase in anxiety was linked with breaking bad news ( P = 0.050 ) and with supportive skills ( P = 0.013 ) . No impact of the training programme was observed . CONCLUSIONS This study shows the influence of some communication skills on the evolution of patients ' anxiety . Physicians should be aware of these influences The provision of adequate information in a clear and sensitive manner can improve cancer patients ' experience of care . Satisfaction with the cancer consultation may impact on satisfaction with care in general and adjustment to the disease . This study aims to identify factors that influence patient and clinician satisfaction with the cancer consultation and whether satisfaction can be improved with communication skills training . 160 doctors from 34 UK cancer centres participated . Half were r and omized to attend a communication skills training course . Patient satisfaction data are presented at baseline and following a communication skills course or in the case of the control doctors , three months after baseline . Clinicians also rated their satisfaction with the consultations . Overall patient satisfaction was not related to the speciality , seniority or sex of the clinician or patient , site of primary cancer or type of treatment . Satisfaction was related to patients ' age , psychological morbidity and , most significantly , satisfaction with the length of wait in clinic . Clinician satisfaction was not related to age , sex or cancer site but clinicians were less satisfied following consultations with patients being treated palliatively . Communication skills training had a non-significant positive effect on patient satisfaction . The subtle benefits of improved communication may be overshadowed by practical problems such as waiting too long to see the doctor , which have an adverse effect on satisfaction The emotional content of health care professionals – cancer patient communication is often considered as poor and has to be improved by an enhancement of health care professionals empathy . One hundred and fifteen oncology nurses participating in a communication skills training workshop were assessed at three different periods . Nurses r and omly allocated to a control group arm ( waiting list ) were assessed a first time and then 3 and 6 months later . Nurses allocated to the training group were assessed before training workshop , just after and 3 months later . Each nurse completed a 20-min clinical and simulated interview . Each interview was analysed by three content analysis systems : two computer-supported content analysis of emotional words , the Harvard Third Psychosocial Dictionary and the Martindale Regressive Imagery Dictionary and an observer rating system of utterances emotional depth level , the Cancer Research Campaign Workshop Evaluation Manual . The results show that in clinical interviews there is an increased use of emotional words by health care professionals right after having been trained ( P=0.056 ) : training group subjects use 4.3 ( std : 3.7 ) emotional words per 1000 used before training workshop , and 7.0 ( std : 5.8 ) right after training workshop and 5.9 ( std : 4.3 ) 3 months later compared to control group subjects which use 4.5 ( std : 4.8 ) emotional words at the first assessment point , 4.3 ( std : 4.1 ) at the second and 4.4 ( std : 3.3 ) at the third . The same trend is noticeable for emotional words used by health care professionals in simulated interviews ( P=0.000 ) . The emotional words registry used by health care professionals however remains stable over time in clinical interviews ( P=0.141 ) and is enlarged in simulated interviews ( P=0.041 ) . This increased use of emotional words by trained health care professionals facilitates cancer patient emotion words expressions compared to untrained health care professionals especially 3 months after training ( P=0.005 ) . This study shows that health care professionals empathy may be improved by communication skills training workshop and that this improvement facilitates cancer patients emotions expression PURPOSE Although it is widely recognised that educational interventions may be more effective for people with an ' internal ' Locus of Control ( who believe that life outcomes are controlled by their own characteristics or actions ) compared to people with an ' external ' Locus of Control ( who believe that life outcomes are controlled by external forces such as luck , fate or others ) , no study has yet assessed the influence of physicians ' Locus of Control ( LOC ) on communication skills learning . This study aims to test the hypothesis that , in a communication skills training program , physicians with an ' internal ' LOC would demonstrate communication skills acquisition to a greater degree than those with an ' external ' LOC . METHODS A non-r and omised longitudinal intervention study was conducted between January 1999 and April 2001 . Sixty-seven volunteer physicians from private and institutional practice in Belgium participated in a learner-centred , skills-focused , practice -oriented communication skills training program . Communication skills changes were assessed in 2 st and ardised simulated interviews before and after training ( one two-person and one three-person interview ) . Communication skills were assessed using the Cancer Research Campaign Workshop Evaluation Manual . Physicians ' LOC was assessed using the Rotter I-E scale . Communication skills changes of the upper and lower third of physicians in respect of their scores on this scale were compared using group by time repeated measures of variance . RESULTS In the two-person and three-person interviews , changes in the use of open directive questions were more important among physicians with an " internal " LOC compared with changes observed among physicians with an ' external ' LOC ( P=0.066 and P=0.004 , respectively ) . In the three-person interview , changes in the use of directive questions , assessing functions and moderate feelings stated explicitly were more important among physicians with an ' internal ' LOC compared with changes observed among physicians with an ' external ' LOC ( P= 0.001 ; P=0.002 and P=0.011 respectively ) . CONCLUSION This study shows that physicians ' LOC is a psychological characteristic that could influence the efficacy of a communication skills training program . This evidence supports the idea that a psychological characteristic such as ' internal ' LOC may facilitate communication skills acquisition through physicians ' belief that communication with patients may be controlled by physicians themselves BACKGROUND Doctors ' communication with patients is commonly hampered by lack of training in this core skill . This study aim ed to assess the efficacy of an intensive 3-day training course on communication skills in a r and omised controlled trial with a two-by-two factorial design and several outcomes . METHODS 160 oncologists from 34 UK cancer centres were r and omly allocated to four groups : written feedback followed by course ; course alone ; written feedback alone ; and control . At each of two assessment periods , consultations with six to ten consecutive , consenting patients per doctor were videotaped . 2407 patients participated . Outcome measures included objective and subjective ratings made by research ers , doctors , and patients . The primary outcomes were objective improvements after the intervention in key communication skills . Course content included structured feedback , videotape review of consultations , role-play with simulated patients , interactive group demonstrations , and discussion led by a trained facilitator . FINDINGS In Poisson regression analysis of counts of communication behaviours , course attendance significantly improved key outcomes . The estimated effect sizes corresponded to higher rates of use of focused questions ( difference between course attenders [ n=80 ] and non-attenders [ n=80 ] 34 % , p=0.003 ) , focused and open questions ( 27 % , p=0.005 ) , expressions of empathy ( 69 % , p=0.003 ) , and appropriate responses to patients ' cues ( 38 % , p=0.026 ) , and a 24 % lower rate of use of leading questions ( p=0.11 ) . There was little evidence for the effectiveness of written feedback . INTERPRETATION The communication problems of senior doctors working in cancer medicine are not resolved by time and clinical experience . This trial shows that training courses significantly improve key communication skills . More re sources should be allocated to address doctors ' training needs in this vital area BACKGROUND No study has yet assessed the impact of physicians ' skills acquisition after a communication skills training program on changes in patients ' and relatives ' anxiety following a three-person medical consultation . This study aim ed at comparing , in a r and omized study , the impact , on patients ' and relatives ' anxiety , of a basic communication skills training program and the same program consoli date d by consolidation workshops and at investigating physicians ' communication variables associated with patients ' and relatives ' anxiety . METHODS Consultations with a cancer patient and a relative were recorded and analyzed by the Cancer Research Campaign Workshop Evaluation Manual . Patients ' and relatives ' anxiety were assessed with the State-Trait Anxiety Inventory-State . RESULTS No statistically significant change over time and between groups was observed . Mixed-effects modeling of changes in patients ' and relatives ' anxiety showed that decreases in both patients ' and relatives ' anxiety were linked with patients ' and relatives ' self-reported distress ( p = 0.031 and 0.005 ) , and that increases in both patients ' and relatives ' anxiety were linked with physicians ' breaking bad news ( p = 0.028 and 0.005 ) . CONCLUSION No impact of the training program was observed . Results indicate the need to further study communication skills which may help reduce patients ' and relatives ' anxiety especially when breaking bad news OBJECTIVES The quality of medical care by somatically treating physicians has considerable influence on the coping process in cancer patients . In outpatient psychosocial care , information supply and doctor-patient interaction are often considered difficult by the patients . This study therefore investigates the effects of a Output:

Training health professionals by CST is a promising approach to change communication behaviour and attitudes .

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***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: A prospect i ve study of the use of transcutaneous neural stimulation ( TNS ) in 90 arthroscopic knee surgery pa tients was performed to determine : ( 1 ) if TNS is as effective as traditional pain medication in treating post operative knee pain ; and ( 2 ) if patients that had received TNS regain preoperative motion and strength quicker than the control population . The patients were divided into three equal groups . Group I consisted of patients with no TNS unit , Group II had a " placebo " unit , and Group III had a " live " unit . Preoperatively , each patient received an isokinetic muscle examination , orientation to the TNS unit , leg circumference measurements , and exercise instruction . An isokinetic muscle examination and leg circumference measurements were repeated at 1 , 3 , and 7 weeks postoperatively . Additionally , the amount of pain and medication required was analyzed . The results of the study indicated that the use of a TNS unit is an effective adjunct in decreasing postoperative pain in 93 % of patients . The amount of pain and total pain medication required was greatest in the control group , less in the placebo , and markedly reduced in the TNS group . A comparison among the three groups revealed that the TNS group regained the following preoperative values 1 month sooner than the other two groups ( 3 as opposed to seven weeks postoperatively ) : isokinetic power in flexion and extension ( P < 0.05 ) , range of motion ( P < 0.02 ) , and leg volume ( P < 0.05 ) . There was no correlation between the pain and irregular wave forms on the isokinetic graph . The only compli cation noted was skin irritation at the electrode sites . TNS has been shown to be a significant benefit in the treatment of postoperative knee pain and in hastening recovery of muscular function through a full range of motion Thirty-six non-hospitalized subjects with chronic pain from OA of the knee participated in an evaluation of transcutaneous electrical nerve stimulation ( TENS ) and naproxen , an NSAID . All pre-experiment treatment was withdrawn . Each subject experienced in some order three 3-week treatment phases : NSAID plus placebo TENS ; TENS plus placebo drug ; and double placebo . A broad range of pain measures was used , including daily diary ratings , and four-times-per-day ratings entered into a small electronic data logger ( the PIPER ) worn by the subject . A substantial placebo response occurred across all conditions , which may have masked treatment differences . Broad comparisons across subjects , combining the four main measures of pain , found no significant differences among the three experimental treatments . Analysis of diary and PIPER data for individuals suggested that , in a small minority of subjects , the NSAID plus placebo TENS combination may be more effective than double placebo . The PIPER ratings seemed to tap aspects of the pain experience different from those captured by conventional measures , suggesting the value of very frequent pain assessment s , such as those entered by a subject into the PIPER , in the study of chronic pain Assessing the quality of r and omized controlled trials ( RCTs ) is important and relatively new . Quality gives us an estimate of the likelihood that the results are a valid estimate of the truth . We present an annotated bibliography of scales and checklists developed to assess quality . Twenty-five scales and nine checklists have been developed to assess quality . The checklists are most useful in providing investigators with guidelines as to what information should be included in reporting RCTs . The scales give readers a quantitative index of the likelihood that the reported methodology and results are free of bias . There are several shortcomings with these scales . Future scale development is likely to be most beneficial if questions common to all trials are assessed , if the scale is easy to use , and if it is developed with sufficient rigor This r and omized study analyzed the effectiveness of postoperative transcutaneous electrical nerve stimulation ( TENS ) used continuously for the first three postoperative days following total knee replacement ( TKR ) for 1 ) pain relief , 2 ) knee flexion arc , 3 ) narcotic dosage , and 4 ) hospital stay . Group 1 ( N = 18 ) received sensory threshold TENS and group 2 ( N = 18 ) received subthreshold TENS . Both groups also used continuous passive motion during their hospitalization as did patients from group 3 ( control , N = 12 ) that did not receive TENS . Pain decrease from postoperative day 1 - 3 was 50 % for group 1 patients and 38 % for group 2 patients , as measured by the visual analog scale . Wilcoxon Rank Sum did not show a significant difference ( p > 0.05 ) for pain relief or hospital stay for these two groups . Analysis of variance failed to show significant differences ( p > 0.05 ) for knee flexion arc or narcotic dosage for the three groups . Although not statistically significant , an observed decrease in pain may be the only indication for postoperative TENS after TKR . J Orthop Sports Phys Ther 1990;11(12):599 - 604 Summary The analgesic effects of high frequency transcutaneous electrical nerve stimulation ( TNS ) , “ acupuncture-like ” TNS and placebo TNS were evaluated in 33 patients with rheumatoid arthritis and chronic h and pain using a r and omized , double-blind , non-crossover design . An oscilloscope was employed to monitor the stimulator output in the TNS treatment groups and to provide strong suggestion and a focus of attention in the placebo treatment group . The two forms of TNS were applied at the highest intensity that could be tolerated by patients . Assessment s of resting pain , joint tenderness , grip strength and grip pain were made before and after treatment . The pain and joint tenderness measurements showed high frequency TNS , “ acupuncture-like ” TNS and placebo TNS to be equally effective in producing analgesia of similar degree and trend over time . The grip strength measurements showed no significant change . The results obtained with placebo are probably due to the suggestion and attention effects of the visual stimulus . The implication s of these results in respect to pain control pathways are discussed . Although TNS given at high intensity was shown to be no better than placebo applied with strong suggestion , this does not preclude its use as a method of pain control in rheumatoid arthritis The therapeutic effect of once weekly transcutaneous electrical nerve stimulation in patients with rheumatoid arthritis was compared with placebo in a r and omised , double-blind , non-crossover study lasting three weeks . Thirty-two patients with classic or definite rheumatoid arthritis and wrist involvement were evaluated . Transcutaneous electrical nerve stimulation was better than the placebo in relieving pain at rest and while gripping . In addition , grip strength , measured as power and work done , immediately improved following transcutaneous electrical nerve stimulation but returned almost to initial values between assessment s. No significant improvement was shown for the placebo group The effect of transcutaneous nerve stimulation ( TNS ) on joint pain was studied in patients with rheumatoid arthritis . Three different forms of TNS were used in an attempt to evaluate the influence of placebo effects . The results were evaluated by means of loading tests and from the patients ' own assessment s of pain relief . High intensity TNS near the painful joint gave pain relief of varying degree in 95 % of the patients , while TNS of low intensity and TNS applied at a remote site gave an improvement in 75 % and 5 % respectively . It seems quite clear that TNS is effective in reducing joint pain . There are a number of factors which intimate that this improvement is not merely a placebo effect The effect of transcutaneous nerve stimulation ( TNS ) was evaluated and compared with placebo TNS in 19 patients ( 17 women , mean age 33 years ) with orofacial functional pain and rheumatic disease involving the temporom and ibular joint . In two double-blind noncrossover experiments , high frequency TNS ( 100 Hz ) and low frequency TNS ( 2 Hz ) were evaluated by comparison of the patients ' functional and rest pain , muscle and joint tenderness , and jaw function . A significant treatment effect was obtained for all treatment methods regarding functional and rest pain and muscle and joint tenderness . None of the parameters except functional pain , which improved significantly more after high frequency TNS than placebo TNS , revealed any difference between the methods . Jaw function , however , revealed a few differences between high frequency TNS and placebo TNS Output:

Results showed a statistically significant reduction in joint tenderness , but no clinical benefit from C-TENS over placebo in relief of joint tenderness . REVIEW ER 'S CONCLUSIONS There are conflicting effects of TENS on pain outcomes in patients with RA . AL-TENS is beneficial for reducing pain intensity and improving muscle power scores over placebo while , conversely , C-TENS result ed in no clinical benefit on pain intensity compared with placebo . However C-TENS result ed in a clinical benefit on patient assessment of change in disease over AL-TENS . More well design ed studies with a st and ardized protocol and adequate number of subjects are needed to fully conclude the effect of C-TENS and AL-TENS in the treatment of RA of the h and

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***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: The effect of 8 wk of progressive bicycle training on the immune system was evaluated in a controlled study on 18 patients with rheumatoid arthritis and moderate disease activity . Maximal O2 uptake increased significantly , whereas heart rate at stage 2 and rate of perceived exertion decreased significantly , in the training group compared with the controls . Resting levels of a number of immune parameters were measured before and after 4 and 8 wk of training . Training did not induce changes in blood mononuclear cell sub population s , proliferative response , or natural killer cell activity . Furthermore the plasma concentrations of interleukin-1 alpha , interleukin-1 beta , and interleukin-6 did not change in response to training . It is concluded that 8 wk of bicycle training does not influence the immune system of patients with rheumatoid arthritis Objective . To evaluate the outcome of resistive home exercise and its possible longterm influence on health , disability , and disease activity in patients with active polymyositis ( PM ) or dermatomyositis ( DM ) . Methods . Nineteen patients with recent-onset PM/DM were included after introduction of high-dose prednisolone . They were assessed by independent assessors as to perceived health , muscle performance , aerobic capacity , and serum creatine phosphokinase ( CPK ) at baseline and after 24 weeks , including repeated muscle biopsies at 24 weeks ( single-blinded r and omized controlled study ) , and in an open-label followup at 52 , 78 , and 104 weeks . Patients were r and omized to 12 weeks , 5 days/week resistive home exercise with telephone support and encouragement for another 12 weeks of twice-a-week home or gym exercise ( EG , n = 10 ) or to 24 weeks , 5 days/week range of motion exercise ( CG , n = 9 ) . Patients in the CG group without inflammatory infiltrates in muscle biopsies at 24 weeks were invited to the 12-week resistive home exercises . Results . At baseline , the EG had poorer perceived health , but otherwise the groups were comparable . At 24 weeks , both groups improved in muscle performance and aerobic capacity ( p < 0.001 to < 0.05 ) with no signs of increased inflammation assessed by CPK levels or muscle biopsies . Both groups improved in muscle performance and aerobic capacity up to 52 weeks ( p < 0.05 ) lasting to 104 weeks in the EG ( p < 0.05 ) and presented minor improvements in perceived health . Conclusion . Our study supports the safety of resistive exercise in patients with active PM/DM but did not reveal any between-group differences in exercise effects . An individually adapted physical therapist – supervised home exercise program might be recommended in early active PM/DM , with regular evaluation of muscle performance and health OBJECTIVE To evaluate the effects of a 12 month , weight bearing , aerobic exercise program on disease activity , physical function , and bone mineral density ( BMD ) in women with rheumatoid arthritis ( RA ) taking low dose prednisone . METHODS A group of women with RA ( n = 23 ) not receiving steroid therapy and in American College of Rheumatology functional class I or II was compared to 30 steroid treated patients with similar demographics . The latter group was r and omized to usual care ( n = 16 ) or an aerobic , weight bearing exercise program ( n = 14 ) 3 times a week for 12 months . All subjects were recruited from an outpatient rheumatology clinic or physical therapy department and met the study inclusion criteria . Outcome measures included disease activity ( erythrocyte sedimentation rate , active joint count ) , physical function ( Health Assessment Question naire disability index , activity level ) and BMD of the spine and femoral neck ( by dual energy projection radiology ) . RESULTS Subjects in the exercise group had a small but nonsignificant decrease in disease activity and statistically significant improvements in function ( p = 0.05 ) and activity levels ( p = 0.05 ) . BMD remained unchanged in the exercise group , decreased significantly ( p = 0.004 ) in the nonsteroid comparison group ( hip ) , and changed nonsignificantly in the control group . However , between-group changes in spinal BMD of the steroid treated groups was not significant ( p = 0.09 ) . CONCLUSION Women with RA taking low dose steroid therapy can safely participate in a dynamic , weight bearing exercise program with positive effects on their physical function , activity and fitness levels , and BMD with no exacerbation of disease activity OBJECTIVE To investigate the effect of long term high intensity weightbearing exercises on radiological damage of the joints of the h and s and feet in patients with rheumatoid arthritis ( RA ) . METHODS Data of the 281 completers of a 2 year r and omised controlled trial comparing the effects of usual care physical therapy ( UC ) with high intensity weightbearing exercises were analysed for the rate of radiological joint damage ( Larsen score ) of the h and s and feet . Potential determinants of outcome were defined : disease activity , use of drugs , change in physical capacity and in bone mineral density , and attendance rate at exercise sessions . RESULTS After 2 years , the 136 participants in high intensity weightbearing exercises developed significantly less radiological damage than the 145 participants in UC . The mean ( SD ) increase in damage was 3.5 ( 7.9 ) in the exercise group and 5.7 ( 10.2 ) in the UC group , p = 0.045 . Separate analysis of the damage to the h and s and feet suggests that this difference in rate of increase of damage is more pronounced in the joints of the feet than in the h and s. The rate of damage was independently associated with less disease activity , less frequent use of glucocorticoids , and with an improvement in aerobic fitness . CONCLUSION The progression of radiological joint damage of the h and s and feet in patients with RA is not increased by long term high intensity weightbearing exercises . These exercises may have a protective effect on the joints of the feet Objective . Sleep disturbance and chronic fatigue are common in rheumatoid arthritis ( RA ) and contribute to disability , symptomatology , and healthcare use . It has long been recognized in other population s that exercise can improve sleep and diminish fatigue . The effect of exercise on sleep quality and fatigue in RA has not been evaluated . Methods . Ours is a r and omized controlled study in RA to determine the effect of an exercise program on sleep quality and fatigue . These were measured using the Pittsburgh Sleep Quality Index and the Fatigue Severity Scale . Patients were r and omized to either a 12-week , home-based exercise intervention or usual care . The exercise program consisted of specific exercises to target individual deficiencies identified using the Health Assessment Question naire ( HAQ ) with cardiovascular work as per the guidelines . The intervention group was evaluated on a 3-week basis . Full evaluation was carried out at baseline and at 12 weeks . Results . Forty patients were r and omized to the intervention with 38 controls . In the exercise intervention group , there was a statistically significant improvement in HAQ ( p = 0.00 ) , pain ( p = 0.05 ) , stiffness ( p = 0.05 ) , sleep quality ( p = 0.04 ) , and fatigue ( p = 0.04 ) . In our control group , there was a statistically significant improvement demonstrated in their overall perceptions of the benefits of exercise , but none of the other variables . Conclusion . Our study demonstrates that an exercise program result ed in significant improvement in sleep quality and fatigue . This is particularly interesting given the importance of fatigue as an outcome measure in RA and gives us yet another reason to prescribe exercise in this population AIM The aim of the study was to compare the effects of conventional exercise ( CE ) , swimming and walking on the pulmonary functions , aerobic capacity , quality of life , Bath indexes and psychological symptoms in patients with ankylosing spondylitis ( AS ) . METHODS Forty-five patients were r and omised into either swimming ( group 1 ) , walking ( group 2 ) , CE group ( group 3 ) . Patients in Group 1 performed CE and swimming , patients in Group 2 performed CE and walking and patients in Group 3 performed CE only . Exercise sessions were performed three times a week for a period of six weeks . Patients were assessed before and after the rehabilitation program , with respect to , pulmonary function test ( forced vital capacity [ FVC , mL ] , forced expiration volume in one second [ FEV1 , mL ] , FEV1/FVC ( % ) and vital capacity [ VC , mL ] ) , maximal oxygen uptake ( pV.O2 ) , 6-minute walking test ( 6MWT ) , Bath Ankylosing Spondylitis Functional Index , Bath Ankylosing Spondylitis Disease Activity Index , Bath Ankylosing Spondylitis Metrology Index , Nottingham Health Profile and Beck Depression Inventory . RESULTS There were significant increases in pVO2 and 6MWT after treatment in Groups 1 and 2 ( P<0.05 ) . FeV1 , FVC and VC improved significantly with treatment in all three groups ( P<0.05 ) . A statistically significant improvement was observed in energy , emotional reaction and physical mobility sub-scores of NHP in three exercise groups after completion of the exercise program ( P<0.05 ) . CONCLUSIONS Swimming , walking and CE had beneficial effects on the quality of life and pulmonary functions . Aerobic exercises such as swimming and walking in addition to CE increased functional capacities of patients Background Physical therapy is recommended for the management of axial spondyloarthritis ( axSpA ) and flexibility exercises have traditionally been the main focus . Cardiovascular ( CV ) diseases are considered as a major health concern in axSpA and there is strong evidence that endurance and strength exercise protects against CV diseases . Therefore , the aim of this study was to investigate the efficacy of high intensity endurance and strength exercise on disease activity and CV health in patients with active axSpA. Methods In a single blinded r and omized controlled pilot study the exercise group ( EG ) performed 12 weeks of endurance and strength exercise while the control group ( CG ) received treatment as usual . The primary outcome was the Ankylosing Spondylitis ( AS ) Disease Activity Score ( ASDAS ) . Secondary outcomes included patient reported disease activity ( Bath AS Disease Activity Index [ BASDAI ] ) , physical function ( Bath AS Functional Index [ BASFI ] ) , and CV risk factors measured by arterial stiffness ( Augmentation Index [ Alx ] ) and Pulse Wave Velocity [ PWV ] ) , cardiorespiratory fitness ( VO2 peak ) and body composition . ANCOVA on the post intervention values with baseline values as covariates was used to assess group differences , and Mann Whitney U-test was used for outcomes with skewed residuals . Results Twenty-eight patients were included and 24 ( EG , n = 10 , CG , n = 14 ) completed the study . A mean treatment effect of −0.7 ( 95%CI : −1.4 , 0.1 ) was seen in ASDAS score . Treatment effects were also observed in secondary outcomes ( mean group difference [ 95%CI ] ) : BASDAI : −2.0 ( −3.6 , −0.4 ) , BASFI : −1.4 ( −2.6 , −0.3 ) , arterial stiffness ( estimated median group differences [ 95 % CI ] ) : AIx ( % ) : −5.3 ( −11.0 , −0.5 ) , and for PVW ( m/s ) : −0.3 ( −0.7 , 0.0 ) , VO2 peak ( ml/kg/min ) ( mean group difference [ 95%CI ] : 3.7 ( 2.1 , 5.2 ) and trunk fat ( % ) : −1.8 ( −3.0 , −0.6 ) . No adverse events occurred . Conclusion High intensity exercise improved disease activity and reduced CV risk factors in patients with active axSpA. These effects will be further explored in a larger trial . Trial Registration Clinical Trials.gov The objective was to study the long-term effect ( 2 years ) of different training programs in patients with rheumatoid arthritis . The method was a r and omized trial with 75 patients participating . The measured variables included morning stiffness , a pain score , number of swollen joints , a health assessment score , a functional score , ESR , Hb , the cost of medicine , and progression using X-rays of h and s and feet . The results showed no effect of training on the disease activity or on the progression of the disease . The conclusion is that although most patients are in favour of training , the present study does not support that training lessons per se affect the disease activity or the progression of the disease OBJECTIVE The benefit of long-term physical training in patients with chronic polymyositis or dermatomyositis ( PM/DM ) was studied prospect ively . METHODS Eight patients with chronic PM/DM participated in a training programme for 6 months . A group of five PM/DM patients without any physical training was observed for control purpose s. RESULTS While there was no significant change in serum creatine phosphokinase ( CPK ) levels , the ' activities of daily living ( ADL ) ' score improved significantly ( P < 0.03 ) , peak isometric torque ( PIT ) generated by muscle groups in the lower extremities rose significantly ( P < 0.03 ) and there was a statistically highly significant increase in peak oxygen uptake ( VO2max ) relative to body weight ( P < 0.02 ) due to the long-term training . The patients improved their aerobic capacity by 28 % , which is clinical ly significant . In the untrained patients , no improvement in these target parameters was observed . CONCLUSION In clinical ly stable DM/PM patients , long-term physical training can safely be performed and is recommended as part of a comprehensive rehabilitation management , particularly in view of the cardiopulmonary risk in these patients O Output:

Beneficial effects were also seen for symptoms . Conclusions The results of this review suggest beneficial effects of exercises on inflammation , joint damage and symptoms in patients with IRDs

MS2_1shot480

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: OBJECTIVES The goal of this study was to determine if restenosis is increased in mild and moderate chronic kidney disease ( CKD ) patients after percutaneous coronary intervention ( PCI ) . BACKGROUND Mortality is increased in CKD after PCI . Restenosis may contribute to increased late mortality . METHODS We analyzed 11,187 patients with a creatinine < 1.8 mg/dl from the Prevention of REStenosis with Tranilast and its Outcomes ( PRESTO ) trial , grouped by estimated creatinine clearance ( CrCl ) ( < 60 , 60 to 89 , > 89 ml/min ) . The Cox proportional hazards models investigated the association between CrCl group and death , myocardial infa rct ion , and target vessel revascularization ( TVR ) . Generalized estimating equation regression models determined the association between CrCl group and lesion-specific restenosis . RESULTS At 30 days , there was no difference in myocardial infa rct ion , death , or TVR between the CrCl groups . At nine months , mortality was higher in the lowest CrCl group ( 2.2 % , 1.2 % , 0.8 % ; p < 0.001 ) , which was no longer significant after adjusting for confounding variables . Myocardial infa rct ion and TVR were not different between the groups . In patients undergoing protocol follow-up angiography , restenosis ( > /=50 % ) was not increased with CKD ( 32 % , 32 % , 37 % ; p = 0.02 ) . CONCLUSIONS Mortality nine months after PCI is mildly increased in mild or moderate CKD patients . However , restenosis is not and does not account for the increased mortality Background —Persons with end-stage renal disease and those with lesser degrees of chronic kidney disease ( CKD ) have an increased risk of death after myocardial infa rct ion ( MI ) that is not fully explained by associated comorbidities . Future cardiovascular event rates and the relative response to therapy in persons with mild to moderate CKD are not well characterized . Methods and Results —We calculated the estimated glomerular filtration rate ( eGFR ) using the 4-variable Modification of Diet in Renal Disease method in 2183 Survival And Ventricular Enlargement ( SAVE ) trial subjects . SAVE r and omized post-MI subjects ( 3 to 16 days after MI ) with left ventricular ejection fraction ≤40 % and serum creatinine < 2.5 mg/dL to captopril or placebo . Cox proportional hazards models were used to evaluate the relative hazard rates for death and cardiovascular events associated with reduced eGFR . Subjects with reduced eGFR were older and had more extensive comorbidities . The multivariable adjusted risk ratio for total mortality associated with reduced eGFR from 60 to 74 , 45 to 59 , and < 45 mL · min−1 · 1.73 m−2 ( compared with eGFR ≥75 mL · min−1 · 1.73 m−2 ) was 1.11 ( 0.86 to 1.42 ) , 1.24 ( 0.96 to 1.60 ) and 1.81 ( 1.32 to 2.48 ) , respectively ( P for trend = 0.001 ) . Similar adjusted trends were present for CV mortality ( P=0.001 ) , recurrent MI ( P=0.017 ) , and the combined CV mortality and morbidity outcome ( P=0.002 ) . The absolute benefit of captopril tended to be greater in subjects with CKD : 12.4 versus 5.5 CV events prevented per 100 subjects with ( n=719 ) and without ( n=1464 ) CKD , respectively . Conclusions —CKD was associated with a heightened risk for all major CV events after MI , particularly among subjects with an estimated glomerular filtration rate < 45 mL · min−1 · 1.73 m−2 . R and omization to captopril result ed in a reduction of CV events irrespective of baseline kidney function OBJECTIVES This study sought to determine the independent association of renal insufficiency with cardiovascular risk among women with known coronary heart disease ( CHD ) . BACKGROUND Although patients with end-stage renal disease and proteinuria are at high risk for cardiovascular events , little is known about the cardiovascular risk associated with moderate renal insufficiency . METHODS The Heart and Estrogen/progestin Replacement Study ( HERS ) was a clinical trial among 2,763 women with coronary disease who were r and omized to conjugated estrogen plus progestins or identical placebo and followed for a mean of 4.1 years . Women were categorized as having normal renal function ( creatinine < 1.2 mg/dl ; n = 2,012 ) , mild renal insufficiency ( 1.2 mg/dl to 1.4 mg/dl ; n = 567 ) and moderate renal insufficiency ( > 1.4 mg/dl ; n = 182 ) . We examined the independent association of renal function with incident cardiovascular events including CHD death , nonfatal myocardial infa rct ion , hospitalization for unstable angina , stroke and transient ischemic attacks . RESULTS Compared with women with normal renal function , those with mild and moderate renal insufficiency were older , more likely to be black , have a history of hypertension and diabetes and have higher serum levels of triglycerides and lipoprotein(a ) . After multivariate adjustment , both mild ( relative hazards [ RH ] = 1.24 ; 95 % confidence interval [ CI ] : 1.0 to 1.5 ) and moderate renal insufficiency ( RH = 1.57 ; 95 % CI : 1.2 to 2.1 ) were independently associated with increased risk for cardiovascular events compared with women with normal renal function . CONCLUSIONS Renal insufficiency is an independent risk factor for cardiovascular events in postmenopausal women with known coronary artery disease . Renal function may add helpful information to CHD risk stratification Background Reduced glomerular filtration rate ( GFR ) is associated with increased cardiovascular risk in young and middle aged individuals . Associations with cardiovascular disease and mortality in older people are less clearly established . We aim ed to determine the predictive value of the GFR for mortality and morbidity using data from the 5,804 participants r and omized in the Prospect i ve Study of Pravastatin in the Elderly at Risk ( PROSPER ) . Methods and Findings Glomerular filtration rate was estimated ( eGFR ) using the Modification of Diet in Renal Disease equation and was categorized in the ranges ( [ 20–40 ] , [ 40–50 ] , [ 50–60 ] ) ≥ 60 ml/min/1.73 m2 . Baseline risk factors were analysed by category of eGFR , with and without adjustment for other risk factors . The associations between baseline eGFR and morbidity and mortality outcomes , accrued after an average of 3.2 y , were investigated using Cox proportional hazard models adjusting for traditional risk factors . We tested for evidence of an interaction between the benefit of statin treatment and baseline eGFR status . Age , low-density lipoprotein ( LDL ) and high-density lipoprotein ( HDL ) cholesterol , C-reactive protein ( CRP ) , body mass index , fasting glucose , female sex , histories of hypertension and vascular disease were associated with eGFR ( p = 0.001 or less ) after adjustment for other risk factors . Low eGFR was independently associated with risk of all cause mortality , vascular mortality , and other noncancer mortality and with fatal and nonfatal coronary and heart failure events ( hazard ratios adjusted for CRP and other risk factors ( 95 % confidence intervals [ CIs ] ) for eGFR < 40 ml/min/1.73m2 relative to eGFR ≥ 60 ml/min/1.73m2 respectively 2.04 ( 1.48–2.80 ) , 2.37 ( 1.53–3.67 ) , 3.52 ( 1.78–6.96 ) , 1.64 ( 1.18–2.27 ) , 3.31 ( 2.03–5.41 ) . There were no nominally statistically significant interactions ( p < 0.05 ) between r and omized treatment allocation and eGFR for clinical outcomes , with the exception of the outcome of coronary heart disease death or nonfatal myocardial infa rct ion ( p = 0.021 ) , with the interaction suggesting increased benefit of statin treatment in subjects with impaired GFRs . Conclusions We have established that , in an elderly population over the age of 70 y , impaired GFR is associated with female sex , with presence of vascular disease , and with levels of other risk factors that would be associated with increased risk of vascular disease . Further , impaired GFR is independently associated with significant levels of increased risk of all cause mortality and fatal vascular events and with composite fatal and nonfatal coronary and heart failure outcomes . Our analyses of the benefits of statin treatment in relation to baseline GFR suggest that there is no reason to exclude elderly patients with impaired renal function from treatment with a statin OBJECTIVES In Incremental Decrease in Endpoints through Aggressive Lipid-lowering ( IDEAL ) , we compared cardiovascular outcomes in patients with and without chronic kidney disease ( CKD ) ( estimated glomerular filtration rate < 60 mL min(-1 ) 1.73 m(-2 ) ) and analysed relationships between lipoprotein components ( LC ) and major coronary events ( MCE ) and other cardiovascular ( CV ) events . DESIGN Exploratory analysis of CV endpoints in a r and omized trial comparing high dose of atorvastatin to usual dose of simvastatin on MCE . SETTING S Patients with CKD were compared with the non-CKD patients . Cox regression models were used to study the relationships between on-treatment levels of LC and incident MCE . FINDINGS Chronic kidney disease was strongly associated with cardiovascular end-points including total mortality . In patients with CKD , a significant benefit of high dose atorvastatin treatment was found for any CV events , stroke and peripheral artery disease , but not for MCE . However , all cardiovascular end-points except stroke and CV mortality were reduced in the non-CKD group . Differential changes in LC or relationships to LC could not explain the different treatment outcomes in MCE in the two groups . INTERPRETATION Chronic kidney disease was a powerful risk factor for all cardiovascular end-points . The reason why the significant reductions achieved by high-dose statin treatment in most CV end-points in the non-CKD group were only in part matched by similar reductions in the CKD patients is not apparent . This difference did not result from differential changes in or relations to LC , but limited power may have increased the possibility of chance findings Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Objective To evaluate the association of kidney function with cardiovascular disease and mortality among apparently healthy women . Design Prospect i ve cohort study . Setting Women ’s Health Study , United States . Participants 27 939 female health professionals aged ≥45 who were free of cardiovascular disease and other major disease and who provided a blood sample at study entry . Main outcome measures Time to cardiovascular disease ( non-fatal stroke , non-fatal myocardial infa rct ion , coronary revascularisation procedures , or death from cardiovascular cause ) , specific cardiovascular disease events , and all-cause mortality . End points were confirmed after review of medical records and death certificates . Results Glomerular filtration rate ( GFR ) was estimated with the abbreviated Modification of Diet in Renal Disease Study equation . At baseline , 1315 ( 4.7 % ) women had GFR < 60 ml/min/1.73 m2 . During 12 years of follow-up , 1199 incident cardiovascular disease events and 856 deaths ( 179 from cardiovascular disease ) occurred . Compared with women with GFR ≥90 ml/min/1.73 m2 , the multivariable adjusted hazard ratios for any first cardiovascular disease were 0.95 ( 95 % CI 0.83 to 1.08 ) , 0.84 ( 0.70 to 1.00 ) , and 1.00 ( 0.79 to 1.27 ) among women with GFR of 75 - 89.9 , 60 - 74.9 , and < 60 ml/min/1.73 m2 , respectively ; the equivalent hazard ratios for all cause mortality were 0.93 ( 0.79 to 1.09 ) , 1.03 ( 0.85 to 1.26 ) , and 1.09 ( 0.83 to 1.45 ) . Similar null findings were observed for myocardial infa rct ion , stroke , coronary revascularisation , and non-cardiovascular death . However , an increased risk of death from cardiovascular disease was found among women with GFR < 60 ml/min/1.73 m2 ( hazard ratio 1.68 Output:

Decreased baseline eGFR is independently associated with increased future myocardial infa rct ion , and the risk increases with advanced renal insufficiency .

MS2_1shot481

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Background Psoriasis is an immunoinflammatory disease associated with cardiovascular risk factors , atherothrombotic events , and hypercoagulability . Venous thromboembolism ( VTE ) is potentially lethal and shares risk factors with psoriasis , but the risk of VTE associated with psoriasis is unknown . The present study investigated the potential association between psoriasis and VTE . Methods and Findings Information from nationwide prospect ively recorded registers of hospitalization , drug dispensing from pharmacies , socio-economic data , and causes of death was linked on an individual level . In an unselected nationwide cohort , we used multivariate Poisson regression models controlling for age , gender , comorbidity , concomitant medication , socio-economic data , and calendar year , to assess the risk of VTE associated with psoriasis . A total of 35,138 patients with mild and 3,526 patients with severe psoriasis were identified and compared with 4,126,075 controls . Patients with psoriasis had higher incidence rates per 1000 person-years of VTE than controls ( 1.29 , 1.92 , and 3.20 for controls , mild psoriasis , and severe psoriasis , respectively ) . The rate ratio ( RR ) of VTE was elevated in all patients with psoriasis with RR 1.35 ( 95 % confidence interval [ CI ] 1.21–1.49 ) and RR 2.06 ( CI 1.63–2.61 ) for mild and severe psoriasis , respectively . Exclusion of patients with malignancies , and censoring of patients undergoing surgery did not alter the results . Conclusion This nationwide cohort study indicates that patients with psoriasis are at increased risk of VTE . The risk was highest in young patients with severe psoriasis . Physicians should be aware that patients with psoriasis may be at increased risk of both venous and arterial thromboembolic events BACKGROUND Psoriasis is a chronic inflammatory disease and is associated with cardiovascular events . Little is known about sub clinical myocardial dysfunction and potential changes in myocardial function during anti-inflammatory treatment in these patients . We prospect ively studied left ventricular function in patients with severe psoriasis who initiated biologic therapy . METHODS Between November 1 2013 and May 31 2014 the study subjects underwent physical , laboratory and comprehensive echocardiographic examination at baseline and after 3 months of treatment . Pearson correlation coefficients and Student 's t-test were applied to assess changes in diastolic function ( defined as the E/e ' ratio ) and global longitudinal strain ( GLS ) . RESULTS Eighteen patients with severe psoriasis treated with biologic therapy with a mean follow-up of 85.6 ± 18.2 days were included . The patients had a baseline psoriasis area and severity index ( PASI ) of 12.0 ± 4.1 and normal left ventricular ejection fraction [ ( LVEF ) 56.3 ± 3.8 % ] , diastolic dysfunction ( E/e ' 8.1 ± 2.1 ) and GLS ( -16.8 ± 2.1 % ) . At follow-up , an improvement ( baseline vs. follow-up ) of PASI ( 12.0 ± 4.1 vs. 2.7 ± 3.1 , P < 0.001 ) , E/e ' ( 8.1 ± 2.1 vs. 6.7 ± 1.9 , P ≤ 0.001 ) and GLS ( -16.8 ± 2.1 vs. -18.3 ± 2.3 % , P < 0.001 ) were recorded . No changes were demonstrated in LVEF ( 56.3 ± 3.8 vs. 56.8 ± 3.3 % , P = 0.31 ) , body mass index ( 30.9 ± 5.7 vs. 31.0 ± 5.8 kg/m(2 ) , P = 0.90 ) , mean arterial blood pressure ( 103.1 ± 8.5 vs. 103.7 ± 10.8 mmHg , P = 0.74 ) . Likewise , no changes were seen in total cholesterol , low density lipoprotein cholesterol , high density lipoprotein cholesterol , estimated glomerular filtration rate and glycosylated haemoglobin . CONCLUSION In patients with severe psoriasis treatment with biologic therapy was associated with improved PASI and amelioration of myocardial dysfunction OBJECTIVES To assess the extent to which abstract s of method ological research , initially presented at meetings on systematic review s , have gone on to be published as full articles . METHODS Full publication was assessed in three ways : a search was carried out of The Cochrane Library ; a search was conducted using MEDLINE ; and a question naire was sent to the contact author of each abstract . RESULTS Approximately half of the abstract s had not been , or were unlikely ever to be , published in full . CONCLUSIONS The rate of full publication of abstract s related to the methodology of systematic review s seems similar to that for r and omized trials AIMS Psoriasis is a chronic inflammatory disease and inflammation contributes to the pathogenesis of atrial fibrillation ( AF ) and ischaemic stroke . We therefore investigated the risk of these endpoints in patients with psoriasis . METHODS AND RESULTS Cohort study of the entire Danish population followed from 1997 to 2006 by individual-level-linkage of nationwide prospect ively recorded registers . Multivariable Poisson 's regression and sensitivity analyses were used to assess the psoriasis-related risk of AF and ischaemic stroke . A total of 36 765 patients with mild psoriasis and 2793 with severe psoriasis were compared with 4 478 926 individuals , i.e. , the reference population . In patients with mild psoriasis , the adjusted rate ratios ( RRs ) for AF were 1.50 ( 1.21 - 1.86 ) and 1.16 ( 1.08 - 1.24 ) in patients aged < 50 and ≥50 years , respectively . Patients with severe psoriasis had a higher risk of AF with RRs 2.98 ( 1.80 - 4.92 ) in patients aged < 50 years and 1.29 ( 1.01 - 1.65 ) in patients aged ≥50 years . Patients with psoriasis also demonstrated a disease severity-dependent increased risk of ischaemic stroke , i.e. RRs 1.97 ( 1.66 - 2.34 ) and 2.80 ( 1.81 - 4.34 ) in patients aged < 50 years with mild and severe psoriasis , and RRs 1.13 ( 1.04 - 1.21 ) and 1.34 ( 1.04 - 1.71 ) in patients aged ≥50 years with mild and severe psoriasis , respectively . A range of sensitivity analyses yielded comparable results . CONCLUSION Psoriasis is associated with increased risk of AF and ischaemic stroke . These novel results add to a growing body of evidence , suggesting that patients with psoriasis could be considered at increased cardiovascular risk OBJECTIVE To compare clinicians ' ratings of therapeutic effectiveness when different trial end points were presented as percent reductions in relative compared with absolute risk and as numbers of patients treated to avoid one adverse outcome . DESIGN Survey , with r and om allocation of two question naires . SETTING Toronto teaching hospitals . RESPONDENTS Convenience sample of 100 faculty and housestaff in internal medicine and family medicine . INTERVENTION One question naire presented results for three end points of the Helsinki Heart Study as separate drug trials using only absolute differences in events ; the other showed the same end points as relative differences . Both question naires included a fourth " trial , " showing person-years of treatment needed to prevent one myocardial infa rct ion . MAIN OUTCOME MEASURE The " trials " were each rated on an 11-point scale , from treatment " harmful " to " very effective . " RESULTS Respondents ' ratings of effectiveness varied with the end point . Controlling for end point , ratings of effectiveness by the 50 participants receiving absolute event data were lower than those by 50 participants responding to relative risk reductions ( P < 0.001 ) ; however , no end-point difference was more than 0.6 scale points . For a " trial " reporting that 77 persons were treated for 5 years to prevent one myocardial infa rct ion , mean ratings were 2.3 or 1.8 scale points lower , respectively ( both P < 0.001 ) , than when the same data were shown as relative or absolute risk reductions . CONCLUSIONS Clinicians ' views of drug therapies are affected by the common use of relative risk reductions in both trial reports and advertisements , by end-point emphasis , and , above all , by underuse of summary measures that relate treatment burden to therapeutic yields in a clinical ly relevant manner Clinical trials may lead to conflicting results . We studied how different ways of reporting results affected physicians ' recommendations . A question naire distributed to 148 general practitioners presented results of a clinical trial where a reduction of cardiac events and an increase of mortality was reported . Results were shown in four different ways -- relative risk reduction , absolute risk reduction , percentages of event-free patients , number needing to be treated to prevent an event -- as if they derived from different trials . A fifth presentation was the reduced rate of cardiac events along with the increased rate of mortality . Physicians were asked to estimate how much they would be willing to prescribe each drug . The mean agreement of physicians ' decisions was 77 (28)% for relative risk reduction , 24 (28)% for absolute risk reduction , 37 (37)% for different percentages event-free patients , 34 (34)% for number need to treat , and 23 (28)% for events reduction and mortality for increase ( p < 0.001 relative risk vs others ) . The method of reporting trial results and the completeness of information in the case of controversial results affects physicians willingness to prescribe Abstract Objective : To determine whether the reporting of study results by using reductions in relative or absolute risk and the number needed to treat affects the views of physicians about the effectiveness of drugs to lower lipid concentrations and decisions about treatment . Design : R and om allocation of two question naires presenting the results of three end points of the Helsinki heart study as results from separate trials by using reduction in either relative or absolute20risk . In both question naires one end point was also presented by showing person years of treatment20needed to prevent one myocardial infa rct ion . The effectiveness of lipid lowering drugs was assessed for all end points on an 11 point scale . For each study result the likelihood to treat hypercholesterolaemia of 7.5 mmol/l in a healthy man had to be indicated on a seven point scale . Subjects : R and om sample of 802 internists and general practioners representative of providers of primary care in Switzerl and . Results - The response rate was 69.6 % ( 558 ) . For the prevention of fatal and non-fatal myocardial infa rct ion the mean ratings of effectiveness of lipid lowering drugs were 0.45 ( 95 % confidence interval 0.21 to 0.69 ) and 1.39 ( 1.09 to 1.68 ) scale points lower when the reduction of absolute risk or number needed to treat were reported instead of the relative risk reduction ( both P<0.001 ) . Physicians receiving trial results for identical end points in form of absolute reduction of risk or number needed to treat were less inclined to treat hypercholesterolaemia ( both P<0.001 ) . Conclusions : Physicians ' views of the effectiveness of lipid lowering drugs and the decision to prescribe such drugs is affected by the predominant use of reduction of relative risk in trial reports and advertisements Output:

Limitations : Data base studies might not fully account for confounders , result ing in overestimates of the risk impact of comorbidities . Conclusions : Presenting attributable risk in the form of the number needed to harm provides a clearer picture of the magnitude of risk and a basis for wiser medical decision making and patient education

MS2_1shot482

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Background Sexual and urinary dysfunction is an established risk after pelvic surgery . Studies examining sexual and urinary function following laparoscopic and open rectal surgery give conflicting evidence for outcomes . The purpose of this study was to analyse the impact of the surgical technique on functional outcomes following laparoscopic or open resection for rectal cancer patients in a high-volume laparoscopic unit . Methods All patients who underwent elective laparoscopic or open surgery for rectal cancer between September 2006 and September 2009 were identified from a prospect ively collated data base . Vali date d st and ardized postal question naires were sent to surviving patients to assess their postoperative sexual and urinary function . The functional data were then quantified using previously vali date d indices of function . Results A total of 173 patients were identified from the data base , of whom 144 ( 83 % ) responded to the question naire-based study . Seventy-eight respondents had undergone laparoscopic rectal resection ( 49 men and 29 women ) , and 65 had an open procedure ( 41 men and 24 women ) . Both open surgery and laparoscopic surgery were associated with deterioration in urinary and sexual function . With regard to urinary function , there was no difference in the deterioration in open and laparoscopic groups in either gender . With regard to sexual function , in males one component of sexual function , namely , the incidence of successful penetration , showed less deterioration in the laparoscopic group ( p = 0.04 ) . However , in females , laparoscopic surgery was associated with significantly better outcomes in all aspects of sexual activity , specifically sexual arousal ( p = 0.005 ) , lubrication ( p = 0.001 ) , orgasm ( p = 0.04 ) , and the incidence of dyspareunia ( p = 0.02 ) . Conclusion Laparoscopic total mesorectal excision for rectal cancer is associated with significantly less deterioration in sexual function compared with open surgery . This effect is particularly pronounced in women Bladder and sexual dysfunction , secondary to pelvic nerve injury , are recognized complications of rectal resection . This study investigated the frequency of these complications following laparoscopically assisted and conventional open mesorectal resection for cancer Objective To assess long-term quality of life in a population -based sample of rectal cancer patients . Summary Background Data Quality of life in rectal cancer patients who suffer reduced bowel and sexual function is very important . Few studies , however , have long term follow-up data or sufficient sample sizes for reliable comparisons between operation groups . Patients and Methods A 4-year prospect i ve study of rectal cancer patients ’ quality of life was assessed by using the European Organization for Research and Treatment of Cancer QLQ-30 and CR38 question naires . Results A total of 329 patients returned question naires . Overall , anterior resection patients had better quality of life scores than abdominoperineal extirpation patients . High-anterior resection patients had significantly better scores than both low-anterior resection and abdominoperineal extirpation patients . Low-anterior resection patients , however , overall had a better quality of life than abdominoperineal extirpation patients , especially after 4 years . Abdominoperineal extirpation patients ’ quality of life scores did not improve over time . Stoma patients had significantly worse quality of life scores than nonstoma patients . Quality of life improved greatly for patients whose stoma was reversed . Conclusions Anterior resection and nonstoma patients , despite suffering micturition and defecation problems , had better quality of life scores than abdominoperineal extirpation and stoma patients . Comparisons between abdominoperineal extirpation and anterior resection patients should consider the effect of temporary stomas . Improvements in quality of life scores over time may be explained by reversal of temporary stomas or physiologic adaptation Only few studies have investigated the impact of surgery for rectal cancer on sexual function . Little of that research included quality of life ( QoL ) aspects and hardly any study analyzed the impact of age , gender and type of surgery on sexual function . The aim of the presented study was to address these issues . Over a 5 y period , EORTC-QLQ-C-30 and a tumor-specific module were prospect ively administered to patients before surgery , at discharge , 3 , 6 , 12 and 24 months postoperatively . Comparisons were made between patients receiving abdominoperineal resection ( APR ) , anterior resection ( AR ) with or without Pouch and Sigmoid resection . Furthermore , effects of surgery on female and male patients , and age groups were analyzed . A total of 819 patients participated in the study : 412 were males and 407 were females . The groups were comparable in terms of adjuvant treatment , tumor stage and histology . Patients after APR and AR with Pouch had worst sexual function . Men reported significantly more difficulties with sexual enjoyment ; furthermore , over time , sexual problems created high levels of strain in men that were worse than baseline levels in the early postoperative period . These problems tended to remain . Patients aged 69 y and younger scored higher for problems with loss of sexual function and sexuality-related strain than patients aged 70 y and older . The findings in this study confirm that QoL changes postsurgery and that factors like type of surgery , gender and age have tremendous impact on sexual function and sexual enjoyment . APR and AR with Pouch affect sexual function more than AR and resection of the lower sigmoid . Through impaired sexual enjoyment , men are put more under strain than women . Patients aged 69 y and younger experience more stress through deteriorated sexual function Background Sexual function may be harmed after treatment for rectal cancer . This study aim ed to evaluate prospect ively the incidence of sexual dysfunction after rectal cancer treatment and to compare the effects of laparoscopic and traditional open approaches in terms of postoperative sexual function . Methods Baseline and 3- , 6- , and 12-month assessment s of sexual dysfunction using the International Index of Erectile Function ( IIEF ) and its specific domains prospect ively took place for 56 patients who underwent rectal cancer surgery ( 38 open vs. 18 laparoscopic procedures , 38 low anterior vs. 18 abdominoperineal resections ) . The preliminary results are presented . Results The average total IIEF and isolated IIEF response domain scores were significantly decreased after surgery ( p < 0.01 ) except for the intercourse satisfaction and overall satisfaction scores at 12 months . An improvement in IIEF scores was observed between the 3- and 6-month assessment points ( p < 0.01 ) except for the erectile function and orgasmic function scores . No significant differences were observed between the open and laparoscopic groups in the total IIEF and domain scores preoperatively and at the 3- and 6-month assessment points . The rates of sexual dysfunction did not differ significantly preoperatively or at 3 months postoperatively when open and laparoscopic procedures were compared , although there was a trend in favor of laparoscopic surgery at 6 months ( p = 0.076 ) . The baseline IIEF score and the baseline , 3- , and 6-month sexual desire scores were better ( p = 0.035 , 0.004 , 0.017 , and 0.061 , respectively ) in the low anterior resection group than in the abdominoperineal resection group . Conclusions Rectal cancer resections were postoperatively associated with a significant reduction in IIEF scores and high rates of sexual dysfunction at 3 and 6 months . The IIEF and domain scores at different assessment points were comparable between the laparoscopic and open surgery groups . Extending the monitoring period and adding more patients in this ongoing prospect i ve study will further eluci date postoperative sexual dysfunction after rectal cancer surgery AIMS To evaluate the health-related quality of life ( HRQoL ) outcomes in patients undergoing laparoscopic total mesorectal excision ( LTME ) with anal sphincter preservation ( ASP ) for low rectal cancers . METHODS Patients undergoing LTME with ASP or open procedures ( OTME ) for low rectal cancers were prospect ively followed up . All patients were treated in curative attempt and were free of local recurrence during the study . HRQoL was assessed by question naires during 3 - 6 months , 12 - 18 months , and 2 - 5 years after surgery . RESULTS From June 2001 to March 2006 , 125 patients undergoing LTME and 103 undergoing OTME were included in this study . In contrast to OTME patients , the LTME ones showed significantly better physical function during 3 - 6 months after surgery , less micturition problems within 12 - 18 months , less male sexual problems and better sexual function during 12 - 18 months after surgery , with better sexual enjoyment after 24 months postoperatively . Both groups showed significant improvement in most subscales from the first to the second assessment , and an improvement in sexual enjoyment from the second to the third assessment . The sexual function , micturition problems and male sexual problems in the LTME group significantly improved from the first to the second assessment , whereas the sexual function in the OTME group improved from the second to the third assessment . CONCLUSIONS Patients undergoing LTME for low rectal cancers can achieve superior postoperative HRQoL than patients undergoing OTME , with superior physical function , micturition function , overall sexual and male sexual functions in the short term , and better sexual enjoyment in the long term . The HRQoL of both LTME and OTME patients may be expected to improve over time , particularly over the first postoperative year BACKGROUND The safety and short-term efficacy of laparoscopic surgery for rectal cancer after preoperative chemoradiotherapy has not been demonstrated . The aim of the r and omised Comparison of Open versus laparoscopic surgery for mid and low REctal cancer After Neoadjuvant chemoradiotherapy ( COREAN ) trial was to compare open surgery with laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy . METHODS Between April 4 , 2006 , and Aug 26 , 2009 , patients with cT3N0 - 2 mid or low rectal cancer without distant metastasis after preoperative chemoradiotherapy were enrolled at three tertiary-referral hospitals . Patients were r and omised 1:1 to receive either open surgery ( n=170 ) or laparoscopic surgery ( n=170 ) , stratified according to sex and preoperative chemotherapy regimen . Short-term outcomes assessed were involvement of the circumferential resection margin , macroscopic quality of the total mesorectal excision specimen , number of harvested lymph nodes , recovery of bowel function , perioperative morbidity , postoperative pain , and quality of life . Analyses were based on the intention-to-treat population . Patients continue to be followed up for the primary outcome ( 3-year disease-free survival ) . This study is registered with Clinical Trials.gov , number NCT00470951 . FINDINGS Two patients ( 1.2 % ) in the laparoscopic group were converted to open surgery , but were included in the laparoscopic group for analyses . Estimated blood loss was less in the laparoscopic group than in the open group ( median 217.5 mL [ 150.0 - 400.0 ] in the open group vs 200.0 mL [ 100.0 - 300.0 ] in the laparoscopic group , p=0.006 ) , although surgery time was longer in the laparoscopic group ( mean 244.9 min [ SD 75.4 ] vs 197.0 min [ 62.9 ] , p<0.0001 ) . Involvement of the circumferential resection margin , macroscopic quality of the total mesorectal excision specimen , number of harvested lymph nodes , and perioperative morbidity did not differ between the two groups . The laparoscopic surgery group showed earlier recovery of bowel function than the open surgery group ( time to pass first flatus , median 38.5 h [ 23.0 - 53.0 ] vs 60.0 h [ 43.0 - 73.0 ] , p<0.0001 ; time to resume a normal diet , 85.0 h [ 66.0 - 95.0 ] vs 93.0 h [ 86.0 - 121.0 ] , p<0.0001 ; time to first defecation , 96.5 h [ 70.0 - 125.0 ] vs 123 h [ 94.0 - 156.0 ] , p<0.0001 ) . The total amount of morphine used was less in the laparoscopic group than in the open group ( median 107.2 mg [ 80.0 - 150.0 ] vs 156.9 mg [ 117.0 - 185.2 ] , p<0.0001 ) . 3 months after proctectomy or ileostomy takedown , the laparoscopic group showed better physical functioning score than the open group ( 0.501 [ n=122 ] vs -4.970 [ n=128 ] , p=0.0073 ) , less fatigue ( -5.659 [ n=122 ] vs 0.098 [ n=129 ] , p=0.0206 ) , and fewer micturition ( -2.583 [ n=122 ] vs 4.725 [ n=129 ] , p=0.0002 ) , gastrointestinal ( -0.400 [ n=122 ] vs 4.331 [ n=129 ] , p=0.0102 ) , Output:

The available data are limited , but suggest that neither form of surgical approach be it laparoscopy or open surgery demonstrate superiority in preservation of sexual and bladder function .

MS2_1shot483

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: OBJECTIVE The reporting of depressive symptoms following myocardial infa rct ion may be confounded by complaints originating from the myocardial infa rct ion . Therefore , it is difficult to estimate the effects of post-myocardial infa rct ion depression and its treatment on cardiovascular prognosis . The authors ' goal was to study the relationship between depressive symptom dimensions following myocardial infa rct ion and both somatic health status and prospect i ve cardiovascular prognosis . METHOD In two studies of myocardial infa rct ion patients ( N=494 and 1,972 ) , the Beck Depression Inventory was used to determine the dimensional structure of depressive symptoms following myocardial infa rct ion . Three symptom dimensions-somatic/affective , cognitive/affective , and appetitive-were compared with baseline left ventricular ejection fraction , Charlson comorbidity index , Killip class , and previous myocardial infa rct ion . The relationship between depressive symptom dimensions and prospect i ve cardiovascular mortality and cardiac-related readmissions was also examined ( mean follow-up duration = 2.5 years ) . RESULTS Somatic/affective symptoms were associated with poor health status ( left ventricular ejection fraction , Charlson comorbidity index , Killip class , and previous myocardial infa rct ion ) and predicted cardiovascular mortality and cardiac events . Cognitive/affective symptoms were only marginally associated with somatic health status and not with cardiovascular death and cardiac events . Appetitive symptoms were related to somatic health status but did not predict cardiovascular death or cardiac events . CONCLUSIONS Somatic/affective depressive symptoms following myocardial infa rct ion were confounded by somatic health status yet were prospect ively associated with cardiac prognosis even after somatic health status was controlled . Cognitive/affective depressive symptoms were only marginally related to health status and not to cardiac prognosis . These findings suggest that treatment of depression following myocardial infa rct ion might improve cardiovascular prognosis when it reduces somatic/affective symptoms BACKGROUND Individual symptoms of post-myocardial infa rct ion ( MI ) depression may be differentially associated with cardiac prognosis , in which somatic/affective symptoms appear to be associated with a worse cardiovascular prognosis than cognitive/affective symptoms . These findings hold important implication s for treatment but need to be replicated before conclusions regarding treatment can be drawn . We therefore examined the relationship between depressive symptom dimensions following MI and both disease severity and prospect i ve cardiac prognosis . METHOD Patients ( n=473 ) were assessed on demographic and clinical variables and completed the Beck Depression Inventory ( BDI ) within the first week of hospital admission for acute MI . Depressive symptom dimensions were associated with baseline left ventricular ejection fraction ( LVEF ) and prospect i ve cardiac death and /or recurrent MI . The average follow-up period was 2.8 years . RESULTS Factor analysis revealed two symptom dimensions -- somatic/affective and cognitive/affective -- in the underlying structure of the BDI , identical to previous results . There were 49 events attributable to cardiac death ( n=23 ) or recurrent MI ( n=26 ) . Somatic/affective ( p=0.010 ) but not cognitive/affective ( p=0.153 ) symptoms were associated with LVEF and cardiac death/recurrent MI . When controlling for the effects of previous MI and LVEF , somatic/affective symptoms remained significantly predictive of cardiac death/recurrent MI ( hazard ratio 1.31 , 95 % confidence interval 1.02 - 1.69 , p=0.038 ) . Previous MI was also an independent predictor of cardiac death/recurrent MI . CONCLUSIONS We confirmed that somatic/affective , rather than cognitive/affective , symptoms of depression are associated with MI severity and cardiovascular prognosis . Interventions to improve cardiovascular prognosis by treating depression should be targeted at somatic aspects of depression BACKGROUND Trait anger , hostility , and serum level of homocysteine are associated with recurrent cardiac events after percutaneous coronary interventions . However , whether trait anger or hostility influences the association between serum level of homocysteine and recurrent cardiac events is unknown . OBJECTIVES To examine the relationships among trait anger , hostility , serum level of homocysteine , and recurrent cardiac events after percutaneous coronary interventions . METHODS This prospect i ve study included 135 consecutive patients ( 68 % male , mean age 61 [ SD , 10 ] years ) undergoing percutaneous coronary interventions during an index hospitalization . Trait anger and hostility were measured with the Spielberger Trait Anger Scale and the Cynical Hostility Scale , respectively . Blood sample s were obtained to measure serum levels of total cholesterol , triglycerides , high- and low-density lipoprotein cholesterol , and homocysteine . Recurrent cardiac events ( emergency department visits and rehospitalization ) were noted for 6 months after discharge and confirmed by review of hospital records . Hierarchical Cox hazard regression was used for statistical analysis . RESULTS Trait anger ( hazard ratio = 1.11 , 95 % confidence interval = 1.03 - 1.20 ) and homocysteine level ( hazard ratio = 1.10 , 95 % confidence interval = 1.01 - 1.21 ) were independent predictors of recurrent cardiac events after other risk factors were controlled for . Patients with high trait anger ( score > or = 24 ) and high serum level of homocysteine ( > or = 11.3 mumol/L ) had the shortest time to recurrent cardiac events ( P = .01 ) . CONCLUSION Trait anger had a combined effect on the link between serum level of homocysteine and recurrent cardiac events . Interventions to reduce trait anger may improve health outcomes by influencing both trait anger and homocysteine level Psychosocial variables predict the recurrence of clinical events in symptomatic patients , controlling for measures of disease severity . The Cardiac Arrhythmia Suppression Trial-1 , a pharmacologic test of the arrhythmia suppression and mortality hypothesis among postmyocardial infa rct ion patients , allowed a prospect i ve test of the relationship of distress , perceived support , social interaction , life stress , and other variables , to mortality , adjusting statistically for ejection fraction , arrhythmia rates , and other known risk factors for coronary heart disease . Results indicated that the treatment medications , encainide and flecainide , were powerful predictors of mortality . Although the psychosocial variables were significant as univariate predictors , these variables were not significant as predictors in a multivariate model that included drug treatment . When the data analysis was restricted to patients r and omized to placebo , thereby eliminating the antiarrhythmic drug effect , the level of perceived social support was a significant multivariate predictor of mortality , adjusting for measures of disease severity . The adjusted hazards ratio for a 1-point decrease in the perceived support score is equal to 1.46 , based on the multivariate model Output:

CONCLUSION Finding suggests that psychological distress in forms of depression , anxiety , anger , and hostility impact unfavorably on recurrent cardiac events in CAD patients

MS2_1shot484

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: The mechanism of high altitude headache ( HAH ) remains unknown . The aim of this study was to determine experimentally whether optic nerve sheath diameter ( ONSD ) , as an indicator of intracranial pressure , is related to HAH . Following sea level measurements at 3 and 12 hours ( SL ) , 23 subjects were passively transported to high altitude ( 3777 m , HA ) via cable car . HAH , ONSD , arterial oxygen saturation ( Spo(2 ) ) , and fluid balance were determined at 3 , 12 , 24 , and 36 hours . After 12 hours exposure to HA , subjects were classified by visual analogue scale ( VAS ) as either HAH positive ( HAH+ ) or HAH negative ( HAH- ) . Acetazolamide ( 250 mg ) or placebo was then r and omly prescribed at 15 , 20 , and 28 hours . Outcome means were compared via analysis of variance , and relationships between variables were analyzed by longitudinal regression . Acetazolamide had no statistically significant effect on HAH ( p=0.63 ) or ONSD ( p=0.98 ) , but produced a negative fluid balance ( p<0.01 ) ( and also increased Spo(2 ) in exploratory analyses ) . Spo(2 ) was lower in HAH+ than HAH- [ 85 (3)% versus 88 (2)% , p=0.03 ) . Nevertheless , ONSD increased similarly in HAH+ and HAH- ( interaction p=0.90 ) . ONSD also remained significantly elevated above SL values for the entire HA period [ SL , 5.2 ( 0.5 ) versus HA , 5.6 ( 0.5 ) mm , p<0.01 ] , despite headache resolving with acclimatization [ VAS : SL , 1/100 ( 3 ) mm versus HA 3 h , 9/100 ( 13 ) ; 12 h , 10/100 ( 14 ) ; 24 h , 8/100 ( 12 ) ; 36 h , 1/100 ( 4 ) mm , p<0.01 ] . Furthermore , HAH was significantly correlated with Spo(2 ) ( β=-1.39 , p<0.01 ) but not with ONSD ( β=0.59 , p=0.57 ) . These data do not support that intracranial pressure is associated with the development or amelioration of mild HAH . Clinical trial registration NCT01288781 Our purpose was to study the preventive effect of the calcium channel blocker flunarizine on headache , postural ataxia , and memory deficits occurring during decompression to high altitude in a r and omized , placebo-controlled , double-blind study . After 7-day pretreatment with the study drugs , 20 healthy men were investigated at 490 m and 0.5 , 2 , 4 , and 6 h later at a simulated altitude of 4559 m. Headache severity was evaluated on a 4-point scale . Sway path and anteroposterior and lateral sway were recorded with open and closed eyes by static posturography . Short- and long-term memory was studied by testing the recall of verbal and figural material immediately and 2 h after presentation , respectively . Blood pressure ( BP ) and arterial oxygen saturation ( Sa(O2 ) ) were also assessed . Headache scores showed a trend to be lower in the flunarizine group that was significant after 4 and 6 h. Headache scores expressed as difference from baseline values showed a nonsignificant trend to be lower at 4 and 6 h in subjects treated with flunarizine . Postural stance , memory , BP , and Sa(O2 ) were similar in both treatment groups . Although the low number of investigated subjects may have prevented the detection of a significant therapeutic effect of flunarizine , the present data do not show that flunarizine is effective for prevention of headache , postural ataxia , and neurocognitive deficits occurring at simulated high altitude BACKGROUND Pulmonary edema results from a persistent imbalance between forces that drive water into the air space and the physiologic mechanisms that remove it . Among the latter , the absorption of liquid driven by active alveolar transepithelial sodium transport has an important role ; a defect of this mechanism may predispose patients to pulmonary edema . Beta-adrenergic agonists up-regulate the clearance of alveolar fluid and attenuate pulmonary edema in animal models . METHODS In a double-blind , r and omized , placebo-controlled study , we assessed the effects of prophylactic inhalation of the beta-adrenergic agonist salmeterol on the incidence of pulmonary edema during exposure to high altitudes ( 4559 m , reached in less than 22 hours ) in 37 subjects who were susceptible to high-altitude pulmonary edema . We also measured the nasal transepithelial potential difference , a marker of the transepithelial sodium and water transport in the distal airways , in 33 mountaineers who were prone to high-altitude pulmonary edema and 33 mountaineers who were resistant to this condition . RESULTS Prophylactic inhalation of salmeterol decreased the incidence of high-altitude pulmonary edema in susceptible subjects by more than 50 percent , from 74 percent with placebo to 33 percent ( P=0.02 ) . The nasal potential-difference value under low-altitude conditions was more than 30 percent lower in the subjects who were susceptible to high-altitude pulmonary edema than in those who were not susceptible ( P<0.001 ) . CONCLUSIONS Prophylactic inhalation of a beta-adrenergic agonist reduces the risk of high-altitude pulmonary edema . Sodium-dependent absorption of liquid from the airways may be defective in patients who are susceptible to high-altitude pulmonary edema . These findings support the concept that sodium-driven clearance of alveolar fluid may have a pathogenic role in pulmonary edema in humans and therefore represent an appropriate target for therapy OBJECTIVES To quantify the changes in ventilatory response and arterial blood gases in healthy male volunteers on acute ascent to 4578 meters altitude along with evaluating the role of acetazolamide and dexamethasone prophylaxis in acclimatisation . METHODS Forty four lowl and er male subjects participated as two groups in the study . Twenty four lowl and er healthy male adults ( age mean + /- SE 27.8 + /- 1.24 years ) comprised the non-acclimatised group . They were sub grouped in a double blind fashion into four . Each subgroup ( n=6 ) received placebo ( multivitamin ) or acetazolamide ( 250 mg ) or dexamethasone ( 4 mg ) or combined regimen of the two drugs twice daily for 5 days commencing 24 hours before ascent . The volunteers reached the altitude of 4578 meters within a span of one day . The second group ( acclimatised ) comprised of age and height matched twenty volunteers who had arrived 4 and 8 weeks earlier at the same altitude . Arterial PO2 , PCO2 , SO2 and minute respiratory rate pH were measured . The pulmonary functions ( FVC , % FEV1 PEF , FEF(25 - 75 % ) and MVV ) were recorded by Compact Spirometer ( Vitalograph ) . Pre and post ascent measurements were carried out in non-acclimatised group whereas one measurement of the same parameters were made in acclimatised group . RESULTS The study revealed a significant increase in respiratory rate min-1 after 24 hours of ascent along with reduction in PaO2 and SaO2 . The gradual increase in PaO2 and SaO2 and reduction in PaCO2 was observed after 4 weeks at the same altitude . The reduction in FVC , % FEV1 , PEF , FEF(25 - 75 % ) and MW were recorded in our subjects after 24 hours of acute ascent . Nevertheless , all pulmonary parameters in volunteers having 8 weeks of stay at 4578 m altitude , were found equivalent to the non-acclimatised group . The greater increase in minute respiratory rate , PaO2 , SaO2 and pulmonary functions was found in volunteers taking acetazolamide . CONCLUSION It is concluded that hyperventilation and increase in lung volumes are the adaptive pulmonary responses which help in improving levels of PaO2 and SaO2 . The acetazolamide-dexamethasone prophylaxis appears beneficial in promoting pulmonary acclimatisation during hypobaric hypoxia Context Very few trials have evaluated ways to prevent high-altitude pulmonary edema ( HAPE ) . Contribution In this double-blind trial , 29 adults with a history of HAPE were r and omly assigned to receive prophylactic tadalafil , dexamethasone , or placebo during a 24-hour ascent and 2-day stay at 4559 m. Compared with placebo recipients , adults taking dexamethasone less often experienced acute mountain sickness and those taking either dexamethasone or tadalafil less often had HAPE . Caution s The trial involved a small number of selected adults who rapidly ascended to a high altitude . Implication s Either tadalafil or dexamethasone might help prevent HAPE in mountaineers with a history of pulmonary edema . The Editors Rapid ascent to altitudes greater than 2500 m may cause acute mountain sickness ( AMS ) and high-altitude pulmonary edema ( HAPE ) . In nonacclimatized mountaineers , the prevalences of AMS and HAPE at 4559 m are approximately 50 % and 4 % , respectively ( 1 ) . Individual susceptibility , rate of ascent , and preexposure to high altitude are major , independent determinants of the prevalence of AMS ( 2 ) . Acute mountain sickness is not a prerequisite for HAPE . Acetazolamide ( 3 , 4 ) or dexamethasone ( 5 , 6 ) prophylaxis can prevent AMS , whereas nifedipine prophylaxis can prevent HAPE ( 7 ) . Whether acetazolamide or dexamethasone also prevents HAPE has not been studied . Exaggerated hypoxic pulmonary vasoconstriction leading to elevated pulmonary capillary pressure ( 8) is the major pathophysiologic mechanism of HAPE . This elevated pulmonary capillary pressure may be caused by inhomogeneous hypoxic pulmonary vasoconstriction ( 9 ) , which leads to areas that are subjected to high pressure and flow , consequent mechanical overdistention of pulmonary capillaries , and injury of the bloodgas barrier ( 10 ) . This phenomenon causes extravasation of fluid , plasma proteins , and blood cells into the interstitial and alveolar spaces ( 11 ) . Decreased bioavailability of nitric oxide might explain the elevated pulmonary artery pressure ( 12 , 13 ) . Therefore , phosphodiesterase-5 inhibitors are an attractive option to restore impaired effects of nitric oxide in persons susceptible to HAPE ( 1416 ) . Constitutively impaired sodium and water transport in the lung has been thought to be an additional factor in the pathogenesis of HAPE ( 17 , 18 ) . Hypoxia also decreases water reabsorption from the alveolar space . Direct experimental evidence has been obtained from hypoxia-exposed rats ( 19 ) , and indirect evidence derives from decreased sodium transport activity in cultured alveolar epithelial cells ( 20 ) . Prophylactic inhalation of the 2-adrenergic agonist salmeterol to stimulate alveolar sodium transport ( 17 ) decreased the incidence of HAPE in susceptible persons . However , other mechanisms of action may also contribute to the preventive effects of salmeterol , because -adrenergics tighten the endothelial barrier and decrease pulmonary artery pressure ( 21 ) . Dexamethasone may be an alternative therapy to prevent HAPE because it stimulates alveolar sodium and water reabsorption ( 22 ) ; may enhance nitric oxide availability in pulmonary vessels ( 23 , 24 ) ; and is effective against AMS ( 5 , 6 ) , which may develop despite use of nifedipine as prophylaxis against HAPE ( 25 ) . However , HAPE has occurred in persons who received dexamethasone for AMS ( 26 , 27 ) . We sought to test whether prophylaxis with dexamethasone or tadalafil reduces the risk for HAPE in adults with a history of HAPE on rapid ascent to 4559 m. Methods Sample and Setting Mountaineers with a history of HAPE were recruited through announcements in the journals of the Swiss Alpine Club and the German Alpine Club . Four women and 25 men with at least 1 documented episode of HAPE participated after providing written informed consent . Table 1 shows the age and average number of HAPE episodes for each participant . No participant spent more than 4 nights above 2500 m within 30 days before ascent to the Capanna Regina Margherita , Italy ( altitude , 4559 m ) . Table 1 . Participant Characteristics Two to 4 weeks before the study at the Capanna Regina Margherita , baseline evaluations were performed in Zrich , Switzerl and ( altitude , 490 m ) . For ascent , participants traveled to Alagna , Italy ( altitude , 1100 m ) , ascended to 3200 m by cable car , and continued by foot to the Capanna Gnif Output:

Our assessment of the most commonly-used pharmacological interventions suggests that acetazolamide is an effective pharmacological agent to prevent acute HAI in dosages of 250 to 750 mg/day . Acetazolamide is associated with an increased risk of paraesthesia , although there are few reports about other adverse events from the available evidence .

MS2_1shot485

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Objectives To investigate the effects of a Mediterranean type diet on patients with osteoarthritis ( OA ) . Participants Ninety-nine volunteers with OA ( aged 31 - 90 years ) completed the study ( 83 % female ) . Setting Southeast of Engl and , UK . Design Participants were r and omly allocated to the dietary intervention ( DIET , n = 50 ) or control ( CON , n = 49 ) . The DIET group were asked to follow a Mediterranean type diet for 16 weeks whereas the CON group were asked to follow their normal diet . Measurements All participants completed an Arthritis Impact Measurement Scale ( AIMS 2 ) pre- , mid- and post- study period . A subset of participants attended a clinic at the start and end of the study for assessment of joint range of motion , ROM ( DIET = 33 , CON = 28 ) , and to provide blood sample s ( DIET = 29 , CON = 25 ) for biomarker analysis ( including serum cartilage oligomeric matrix protein ( sCOMP ) ( a marker of cartilage degradation ) and a panel of other relevant biomarkers including pro- and anti-inflammatory cytokines ) . Results There were no differences between groups in the response of any AIMS 2 components and most biomarkers ( p > 0.05 ) , except the pro-inflammatory cytokine IL-1α , which decreased in the DIET group ( ~47 % , p = 0.010 ) . sCOMP decreased in the DIET group by 1 U/L ( ~8 % , p = 0.014 ) . There was a significant improvement in knee flexion and hip rotation ROM in the DIET group ( p < 0.05 ) . Conclusions The average reduction in sCOMP in the DIET group ( 1 U/L ) represents a meaningful change , but the longer term effects require further study The unsaponifiable fraction of olive oil from unripe fruits of Olea europaea at different stages of maturation ( from 20 to 32 weeks after flowering ) was analyzed by gas chromatography-mass spectrometry in order to select the time associated to the unsaponifiable fraction with the maximal yield in bioactive constituents . According to quantitative gas chromatography-mass spectrometry analysis , the unsaponifiable fraction ( 2.46 % of the total oil ) from olive fruits at the 22nd week was found to contain the maximal yield in anti-inflammatory constituents . Its composition was lanosterol ( 2.60 mg/g oil ) , stigmasterol ( 2.15 ) , cycloartanol acetate ( 2.04 ) , stigmastan-3,5-diene ( 2.01 ) , obtusifoliol ( 1.93 ) , cholesta-4,6-dien-3-one ( 1.42 ) , α-amyrin ( 1.42 ) , α-tocopherol ( 1.32 ) , squalene ( 1.02 ) , β-amyrin ( 0.57 ) , and β-sitosterol ( 0.22 ) . At later times , there was a decrease in the quantitative unsaponifiable fraction yield and a qualitative shift in the bioactive constituents . The 22nd week unsaponifiable fraction was subsequently incorporated into a topical preparation to be utilized for a small pilot clinical study in five patients affected by osteoarthrosis . According to clinical observation , the application of the ointment ( three times daily for three weeks ) attenuated h and and knee joint inflammatory features in all patients and was not associated to any adverse reactions Hydroxytyrosol is mainly found in olive leaves after hydrolysis of oleuropein and has anti-oxidant , anti-bacterial , and anti-inflammatory properties . The aim of this study was to investigate the effect of hydroxytyrosol for alleviating the pain in patients with gonarthrosis . We conducted a double-blind clinical trial in which hydroxytyrosol or placebo was administered to adult patients with gonarthrosis for 4 weeks . The group administered hydroxytyrosol showed significant improvement in the Japanese Orthopedic Association score ( pain measurement index ) and the visual analog scale score compared to the placebo group O steoarthritis ( OA ) is the most common type of arthritis , and the knee is the most common site of symptomatic OA . Knee OA is responsible for a higher incidence of disability than any other long-term conditions . Topical therapies present a therapeutic option for OA pain management . Nonsteroidal antiinflammatory drugs ( NSAIDs ) , salicylates , and capsaicin are currently the main topical therapies available . There is a need for safe and effective drugs for patients who do not respond well to conventional medical therapy . Indeed , such patients are turning increasingly to complementary/alternative medicines . One of the traditional methods for management of knee pain in some rural area of Iran is application of topical olive oil , as reported by Avicenna in his 10th-century book Canon of Medicine . Although the composition of olive oil is complex , the major groups of compounds thought to contribute to its observed health benefits include oleic acid , phenolics , and squalene , all of which have been reported to inhibit oxidative stress . Research ers reported beneficial effects of olive oil on rheumatoid arthritis after oral consumption . In 2005 , (j)-oleocanthal , the dialdehydic form of (j)-deacetoxy-ligstroside aglycone present in freshly pressed extra virgin olive oil , was shown to have properties of an NSAID . Although topical virgin olive oil is traditionally used in Iran in treating knee pain as an herbal medication , our survey did not find any scientific evaluation of its efficacy . Accordingly , we conducted a pilot prospect i ve , comparative , r and omized , doubleblinded trial of topical virgin olive oil therapy versus piroxicam gel in the treatment of knee OA . The report was prepared as recommended by the CONSORT statement and its elaboration on herbal interventions IMPORTANCE Knee osteoarthritis ( OA ) , a common cause of chronic pain and disability , has biomechanical and inflammatory origins and is exacerbated by obesity . OBJECTIVE To determine whether a ≥10 % reduction in body weight induced by diet , with or without exercise , would improve mechanistic and clinical outcomes more than exercise alone . DESIGN , SETTING , AND PARTICIPANTS Single-blind , 18-month , r and omized clinical trial at Wake Forest University between July 2006 and April 2011 . The diet and exercise interventions were center-based with options for the exercise groups to transition to a home-based program . Participants were 454 overweight and obese older community-dwelling adults ( age ≥55 years with body mass index of 27 - 41 ) with pain and radiographic knee OA . INTERVENTIONS Intensive diet-induced weight loss plus exercise , intensive diet-induced weight loss , or exercise . MAIN OUTCOMES AND MEASURES Mechanistic primary outcomes : knee joint compressive force and plasma IL-6 levels ; secondary clinical outcomes : self-reported pain ( range , 0 - 20 ) , function ( range , 0 - 68 ) , mobility , and health-related quality of life ( range , 0 - 100 ) . RESULTS Three hundred ninety-nine participants ( 88 % ) completed the study . Mean weight loss for diet + exercise participants was 10.6 kg ( 11.4 % ) ; for the diet group , 8.9 kg ( 9.5 % ) ; and for the exercise group , 1.8 kg ( 2.0 % ) . After 18 months , knee compressive forces were lower in diet participants ( mean , 2487 N ; 95 % CI , 2393 to 2581 ) compared with exercise participants ( 2687 N ; 95 % CI , 2590 to 2784 , pairwise difference [Δ](exercise vs diet ) = 200 N ; 95 % CI , 55 to 345 ; P = .007 ) . Concentrations of IL-6 were lower in diet + exercise ( 2.7 pg/mL ; 95 % CI , 2.5 to 3.0 ) and diet participants ( 2.7 pg/mL ; 95 % CI , 2.4 to 3.0 ) compared with exercise participants ( 3.1 pg/mL ; 95 % CI , 2.9 to 3.4 ; Δ(exercise vs diet + exercise ) = 0.39 pg/mL ; 95 % CI , -0.03 to 0.81 ; P = .007 ; Δ(exercise vs diet ) = 0.43 pg/mL ; 95 % CI , 0.01 to 0.85 , P = .006 ) . The diet + exercise group had less pain ( 3.6 ; 95 % CI , 3.2 to 4.1 ) and better function ( 14.1 ; 95 % CI , 12.6 to 15.6 ) than both the diet group ( 4.8 ; 95 % CI , 4.3 to 5.2 ) and exercise group ( 4.7 ; 95 % CI , 4.2 to 5.1 , Δ(exercise vs diet + exercise ) = 1.02 ; 95 % CI , 0.33 to 1.71 ; P(pain ) = .004 ; 18.4 ; 95 % CI , 16.9 to 19.9 ; Δ(exercise vs diet + exercise ) , 4.29 ; 95 % CI , 2.07 to 6.50 ; P(function ) < .001 ) . The diet + exercise group ( 44.7 ; 95 % CI , 43.4 to 46.0 ) also had better physical health-related quality of life scores than the exercise group ( 41.9 ; 95 % CI , 40.5 to 43.2 ; Δ(exercise vs diet + exercise ) = -2.81 ; 95 % CI , -4.76 to -0.86 ; P = .005 ) . CONCLUSIONS AND RELEVANCE Among overweight and obese adults with knee OA , after 18 months , participants in the diet + exercise and diet groups had more weight loss and greater reductions in IL-6 levels than those in the exercise group ; those in the diet group had greater reductions in knee compressive force than those in the exercise group . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00381290 Output:

The prevalence of OA was lower in participants with a higher adherence to a Mediterranean diet . Biomarkers of inflammation and cartilage degradation related to OA were also analyzed and significant differences were detected only for IL1-α , which decreased in the MD group . In conclusion , the three studies included in this systematic review demonstrated some relation between osteoarthritis and a Mediterranean diet .

MS2_1shot486

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Background Depression accounts for the greatest burden of disease among all mental health problems , and is expected to become the second-highest amongst all general health problems by 2020 . By the age of 75 , 1 in 7 older people meet formal diagnostic criteria for depression . Efforts to ameliorate the burden of illness and personal suffering associated with depression in older people have focussed on those with more severe depressive syndromes . Less attention has been paid to those with mild disorders/sub-threshold depressive syndromes but these patients also suffer impairments in their quality of life and level of functioning . Methods / Design The CASPER study has been design ed to assemble an epidemiological cohort of people over 75 years of age ( the CASPER cohort ) , from which we will identify those eligible to participate in a trial of collaborative care for sub-threshold depression ( the CASPER trial).We aim to undertake a pragmatic r and omised controlled multi-centre trial evaluating the effectiveness and cost-effectiveness of collaborative care ; a low intensity psychological intervention in addition to usual general practitioner care versus usual general practitioner care alone . General practitioners from practice s based in the North of Engl and will be asked to identify potentially eligible patients over the age of 75 years . Patients will be sent a letter inviting them to participate in the study .We aim to recruit approximately 540 participants for the CASPER trial . A diagnostic interview will be carried out to ascertain trial eligibility with the major depressive episode module of the Mini International Neuropsychiatric Interview ( M.I.N.I. ) , eligible participants r and omised to either the intervention or usual care . The primary outcome will be measured with the Patient Health Question naire-9 ( PHQ-9 ) and additional quality of life measures will be collected . Data will be collected at baseline , 4 and 12 months for both trial and cohort participants .Trial Registration IS RCT N : IS RCT BACKGROUND Thus far collaborative stepped care ( CSC ) studies have not incorporated self-help as a first step . AIMS To evaluate the effectiveness of CSC in the treatment of common mental disorders . METHOD An 8-month cluster r and omised controlled trial comparing CSC to care as usual ( CAU ) ( Dutch Trial Register identifier NTR1224 ) . The CSC consisted of a stepped care approach guided by a psychiatric nurse in primary care with the addition of antidepressants dependent on the severity of the disorder , followed by cognitive-behavioural therapy in mental healthcare . RESULTS Twenty general practitioners ( GPs ) and 8 psychiatric nurses were r and omised to provide CSC or CAU . The GPs recruited 163 patients of whom 85 % completed the post-test measurements . At 4-month mid-test CSC was superior to CAU : 74.7 % ( n = 68 ) v. 50.8 % ( n = 31 ) responders ( P = 0.003 ) . At 8-month post-test and 12-month follow-up no significant differences were found as the patients in the CAU group improved as well . CONCLUSIONS Treatment within a CSC model result ed in an earlier treatment response compared with CAU Background Psychological distress is common in cancer survivors . Although there is some evidence on effectiveness of psychosocial care in distressed cancer patients , referral rate is low . Lack of adequate screening instruments in oncology setting s and insufficient availability of traditional models of psychosocial care are the main barriers . A stepped care approach has the potential to improve the efficiency of psychosocial care . The aim of the study described herein is to evaluate efficacy of a stepped care strategy targeting psychological distress in cancer survivors . Methods / design The study is design ed as a r and omized clinical trial with 2 treatment arms : a stepped care intervention programme versus care as usual . Patients treated for head and neck cancer ( HNC ) or lung cancer ( LC ) are screened for distress using OncoQuest , a computerized touchscreen system . After stratification for tumour ( HNC vs. LC ) and stage ( stage I/II vs. III/IV ) , 176 distressed patients are r and omly assigned to the intervention or control group . Patients in the intervention group will follow a stepped care model with 4 evidence based steps : 1 . Watchful waiting , 2 . Guided self-help via Internet or a booklet , 3 . Problem Solving Treatment administered by a specialized nurse , and 4 . Specialized psychological intervention or antidepressant medication . In the control group , patients receive care as usual which most often is a single interview or referral to specialized intervention . Primary outcome is the Hospital Anxiety and Depression Scale ( HADS ) . Secondary outcome measures are a clinical level of depression or anxiety ( CIDI ) , quality of life ( EQ-5D , EORTC QLQ-C30 , QLQ-HN35 , QLQ-LC13 ) , patient satisfaction with care ( EORTC QLQ-PATSAT ) , and costs ( health care utilization and work loss ( TIC-P and PRODISQ modules ) ) . Outcomes are evaluated before and after intervention and at 3 , 6 , 9 and 12 months after intervention . Discussion Stepped care is a system of delivering and monitoring treatments , such that effective , yet least re source -intensive , treatment is delivered to patients first . The main aim of a stepped care approach is to simplify the patient pathway , provide access to more patients and to improve patient well-being and cost reduction by directing , where appropriate , patients to low cost (self-)management before high cost specialist services . Trial registration Background Depressive and anxiety disorders are common in general practice but not always treated adequately . Introducing stepped care might improve this . In this r and omized trial we examined the effectiveness of such a stepped care model . Methods The study population consisted of primary care attendees aged 18 - 65 years with minor or major DSM-IV depressive and /or anxiety disorders , recruited through screening . We r and omized 120 patients to either stepped care or care as usual . The stepped care program consisted of ( 1 ) watchful waiting , ( 2 ) guided self-help , ( 3 ) short face-to-face Problem Solving Treatment and ( 4 ) pharmacotherapy and /or specialized mental health care . Patients were assessed at baseline and after 8 , 16 and 24 weeks . Results Symptoms of depression and anxiety decreased significantly over time for both groups . However , there was no statistically significant difference between the two groups ( IDS : P = 0.35 and HADS : P = 0.64 ) . The largest , but not significant , effect ( d = -0.21 ) was found for anxiety on T3 . In both groups approximately 48 % of the patients were recovered from their DSM-IV diagnosis at the final 6 months assessment . Conclusions In summary we could not demonstrate that stepped care for depression and anxiety in general practice was more effective than care as usual . Possible reasons are discussed . Trial Registration Current Controlled Trails : IS RCT N17831610 Hedges ( 2018 ) encourages us to consider asking new scientific questions concerning the optimization of adaptive interventions in education . In this commentary , we have exp and ed on this ( albeit briefly ) by providing concrete examples of scientific questions and associated experimental design s to optimize adaptive interventions , and commenting on some of the ways such design s might challenge us to think differently . A great deal of method ological work remains to be done . For example , we have only begun to consider experimental design and analysis methods for developing " cluster-level adaptive interventions " ( NeCamp , Kilbourne , & Almirall , 2017 ) , or to extend methods for comparing the marginal mean trajectories between the adaptive interventions embedded in a SMART ( Lu et al. , 2016 ) to accommo date r and om effects . These method ological advances , among others , will propel educational research concerning the construction of more complex , yet meaningful , interventions that are necessary for improving student and teacher outcomes Background Faced with a life-threatening illness , such as cancer , many patients develop stress symptoms , i.e. avoidance behaviour , intrusive thoughts and worry . Stress management interventions have proven to be effective ; however , they are mostly performed in group setting s and it is commonly breast cancer patients who are studied . We hereby present the design of a r and omized controlled trial ( RCT ) evaluating the effectiveness and cost-effectiveness of an individual stress-management intervention with a stepped-care approach in several cancer diagnoses . Method Patients ( ≥ 18 years ) with a recent diagnosis of breast cancer , colorectal cancer , lymphoma , prostate cancer or testicle cancer and scheduled for adjuvant/curative oncology treatment , will consecutively be included in the study . In this prospect i ve longitudinal intervention study with a stepped-care approach , patients will be r and omized to control , treatment as usual , or an individual stress-management intervention in two steps . The first step is a low-intensity stress-management intervention , given to all patients r and omized to intervention . Patients who continue to report stress symptoms after the first step will thereafter be given more intensive treatment at the second step of the programme . In the intervention patients will also be motivated to be physically active . Avoidance and intrusion are the primary outcomes . According to the power analyses , 300 patients are planned to be included in the study and will be followed for two years . Other outcomes are physical activity level , sleep duration and quality recorded objective ly , and anxiety , depression , quality of life , fatigue , stress in daily living , and patient satisfaction assessed using valid and st and ardized psychometric tested question naires . Utilization of hospital services will be derived from the computerized patient administration systems used by the hospital . The cost-effectiveness of the intervention will be evaluated through a cost-utility analysis . Discussion This RCT will provide empirical evidence of whether an individually administered stress-management programme in two steps can decrease stress as well as maintain or enhance patients ’ physical activity level , quality of life and psychological well-being . Further , this RCT , with a stepped-care approach , will provide knowledge regarding the cost-effectiveness of an individually administered stress-management programme whose aim is to help and support individual patients at the right level of care . Trial registration Clinical Trials.gov Identifier : NCT 01588262 Background This study compared the best available treatment for bulimia nervosa , cognitive – behavioural therapy ( CBT ) augmented by fluoxetine if indicated , with a stepped-care treatment approach in order to enhance treatment effectiveness . Aims To establish the relative effectiveness of these two approaches . Method This was a r and omised trial conducted at four clinical centres ( Clinical trials.gov registration number : NCT00733525 ) . A total of 293 participants with bulimia nervosa were r and omised to one of two treatment conditions : manual-based CBT delivered in an individual therapy format involving 20 sessions over 18 weeks and participants who were predicted to be non-responders after 6 sessions of CBT had fluoxetine added to treatment ; or a stepped-care approach that began with supervised self-help , with the addition of fluoxetine in participants who were predicted to be non-responders after six sessions , followed by CBT for those who failed to achieve abstinence with self-help and medication management . Results Both in the intent-to-treat and completer sample s , there were no differences between the two treatment conditions in inducing recovery ( no binge eating or purging behaviours for 28 days ) or remission ( no longer meeting DSM – IV criteria ) . At the end of 1-year follow-up , the stepped-care condition was significantly superior to CBT . Conclusions Therapist-assisted self-help was an effective first-level treatment in the stepped-care sequence , and the full sequence was more effective than CBT suggesting that treatment is enhanced with a more individualised approach BACKGROUND Exposure and response prevention ( ERP ) for obsessive-compulsive disorder ( OCD ) is underutilized , in part because of costs and time requirements . This study extends pilot work investigating the use of a stepped care ERP administration , in which patients are first given a low-intensity , low-cost treatment and the more costly intervention is reserved for those who do not respond to the first intervention . METHODS Thirty adults with OCD were r and omized to receive stepped care ERP or st and ard ERP . Those receiving stepped care started with three sessions over 6 weeks of low-intensity counseling with ERP bibliotherapy ; patients failing to meet strict responder criteria after 6 weeks were given the more traditional treatment of therapist-administered ERP ( 17 sessions twice weekly ) . Those receiving st and ard ERP received the therapist-administered ERP with no lower-intensity lead-in . RESULTS The two treatments were equally efficacious , with 67 % of stepped care completers and 50 % of st and ard treatment completers meeting criteria for clinical ly significant change at posttreatment . Similarly , no differences in client satisfaction ratings were obtained between the two groups . Examination of treatment costs , however , revealed that stepped care result ed in significantly lower costs to patients and third-party payers than did st and ard ERP , with large effect sizes . CONCLUSIONS These results suggest that stepped care ERP can significantly reduce treatment costs , without evidence of diminished treatment efficacy or patient satisfaction . Additional research is needed to determine the long-term efficacy and costs of stepped care for OCD , and to examine the financial and therapeutic impact of implementing stepped care in community setting Background A life threatening illness such as breast cancer can lead to a secondary diagnosis of PTSD ( post traumatic stress disorder ) with intrusive thoughts and avoidance as major symptoms . In a former study by the research group , 80 % of the patients with breast cancer reported a high level of stress symptoms close to the diagnosis , such as intrusive thoughts and avoidance behavior . These symptoms remained high throughout the study . The present paper presents the design of a r and omized study evaluating the effectiveness and cost-effectiveness of a stress management intervention using a stepped-care design . Method Female patients over the age of 18 , with a recent diagnosis of breast cancer and scheduled for adjuvant treatment in the form of Output:

Conclusions Trials of proportionate staged interventions are being used predominantly within the mental health field .

MS2_1shot487

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: The purpose of this study was to evaluate crestal bone loss around 282 two-piece implants with straight ( n = 193 ) and platform-switched ( n = 89 ) abutment connections after placement at various crestal levels . Implants were assigned into two groups according to straight and platform-switched abutment connections . Each group was further subdivided into three groups depending on the location ( supracrestal , crestal , or subcrestal ) of the implant cervical platform . Linear measurements of bone resorption were made from the implant 's platform to the first point of bone-to-implant contact at the time of implant placement and 2 years postrestoration . Data were statistically analyzed . Statistically significant differences were found between subgroups in both straight and platform-switched categories . The only nonstatistically significant difference ( P = .341 ) arose when comparing the supra- and subcrestal locations in the straight abutment connection group . The platform-switched group exhibited significantly less bone loss ( P = .046 ) only in subcrestal locations . The platform-switched concept was not beneficial during the overall comparison , but it was for the subcrestal location of the abutment connection . Crestal placement of the implant-abutment connection result ed in higher marginal bone resorption in both straight and platform-switched abutments BACKGROUND The purpose of this study is to assess the influence of the placement level of implants with a laser-microtextured collar design on the outcomes of crestal bone and soft tissue levels . In addition , we assessed the vertical and horizontal defect fill and identified factors that influenced clinical outcomes of immediate implant placement . METHODS Twenty-four patients , each with a hopeless tooth ( anterior or premolar region ) , were recruited to receive dental implants . Patients were r and omly assigned to have the implant placed at the palatal crest or 1 mm subcrestally . Clinical parameters including the keratinized gingival ( KG ) width , KG thickness , horizontal defect depth ( HDD ) , facial and interproximal marginal bone levels ( MBLs ) , facial threads exposed , tissue-implant horizontal distance , gingival index ( GI ) , and plaque index ( PI ) were assessed at baseline and 4 months after surgery . In addition , soft tissue profile measurements including the papilla index , papilla height ( PH ) , and gingival level ( GL ) were assessed after crown placement at 6 and 12 months post-surgery . RESULTS The overall 4-month implant success rate was 95.8 % ( one implant failed ) . A total of 20 of 24 patients completed the study . At baseline , there were no significant differences between crestal and subcrestal groups in all clinical parameters except for the facial MBL ( P = 0.035 ) . At 4 months , the subcrestal group had significantly more tissue thickness gain ( keratinized tissue ) than the crestal group compared to baseline . Other clinical parameters ( papilla index , PH , GL , PI , and GI ) showed no significant differences between groups at any time . A facial plate thickness ≤1.5 mm and HDD ≥2 mm were strongly correlated with the facial marginal bone loss . A facial plate thickness ≤2 mm and HDD ≥3 were strongly correlated with horizontal dimensional changes . CONCLUSIONS The use of immediate implants was a predictable surgical approach ( 96 % survival rate ) , and the level of placement did not influence horizontal and vertical bone and soft tissue changes . This study suggests that a thick facial plate , small gaps , and premolar sites were more favorable for successful implant clinical outcomes in immediate implant placement The medium-long term success of osseointegrated dental implants is evaluated on the basis of the degree of osseointegration over time , assessed by radiographic or instrumental analysis ( ISQ ) . Over the years , the question has always been which surgical technique can provide a better performance in the medium-long term and , thanks to literature studies , it has been evidence d that there are no differences between " one stage " and " two stage " interventions . The purpose of this study is to evaluate clinical and radiographic parameters , referring to interventions for the insertion of dental implants characterized by a new kind of implant surface ( Synthegra ® GEASS , Udine ) . The prospect i ve study , not r and omized and controlled , referred to the insertion of 18 implants on 9 patients with mono or bilateral edentulism , with measurements at 1 , 3 , 6 and 12 months and an overall follow-up at 3 years , in order to evaluate the different degree of crestal bone resorption using the submerged and transmucosal surgical technique . The results of our study show that there are no differences in the resorption of the two surgical techniques , with an average bone resorption of 2,05±0,16 mm , comparable with values reported in literature BACKGROUND It has been reported in many articles that marginal bone resorptions are prevented by platform-switching design . However , what occurs when these implants are placed in the apical position is not completely known . PURPOSE This report describes a r and omized controlled clinical trial study that aims to test the hypothesis that less resorption will occur when platform-switching implants are placed 1 mm below bone level . MATERIAL S AND METHODS A total of 56 r and omly selected implants were inserted bilaterally , either 1 mm below bone level ( test group , 28 implants ) or at bone level ( control group , 28 implants ) of the patients ' posterior regions . Marginal bone resorptions were examined through periapical radiographies taken with the parallel technique at the time of crown cementation and the third , sixth , 12th , and 36th months after prosthetic loading . The modified plaque index , gingival index , bleeding on probing , and probing depths were used for follow-up periodontal care of the implants . RESULTS After 3 years , the mean radiographic vertical bone loss in the control group was significantly lower than in the test group ( 0.56 ± 0.35 mm and 1.21 ± 1.05 mm , respectively ) ( p < .01 ) . In terms of periodontal indexes , there were no statistically significant differences between the two groups ( p > .05 ) . No peri-implantitis or peri-implant mucositis was observed around the test or control implants . CONCLUSIONS More marginal bone resorptions occurred after the third year of loading in implants placed 1 mm below bone level . However , the resorptions did not reach the implants thread . In the control group , the first bone implant contact was placed under the level of the first threads . Therefore , the present r and omized clinical trial confirmed the hypothesis that placing platform-switching implants 1 mm below bone level reduced marginal bone loss . It can be noted that to reduce resorption , platform-switching implants should be placed below bone level OBJECTIVES To assess the impact of microgrooved abutments and the insertion depth on crestal bone changes at titanium implants with platform switch . MATERIAL S AND METHODS A total of n = 3 titanium implants ( conical abutment connection ) were inserted in each hemim and ible of n = 6 foxhounds with the implant shoulder ( IS ) located at either epicrestal , supracrestal ( + 1 mm ) , or subcrestal ( -1 mm ) positions and r and omly ( split-mouth design ) connected with machined or partially microgrooved healing abutments . At 20 weeks , tissue biopsies were processed for histological ( primary outcome : net bone loss - NET ) analyses . RESULTS Subcrestal positioning of IS tended to be associated with higher mean NET values ( mm ) at both machined ( subcrestal [ -0.72 ± 0.32 ] > epicrestal [ -0.34 ± 0.21 ] > supracrestal [ + 0.20 ± 0.64 ] ) and microgrooved ( subcrestal [ -0.48 ± 0.25 ] > epicrestal [ -0.13 ± 0.54 ] > supracrestal [ + 0.33 ± 0.58 ] ) abutments . However , these differences failed to reach statistical significance . CONCLUSIONS The insertion depth may have a direct influence on crestal bone-level changes at both types of abutments investigated OBJECTIVE This prospect i ve r and omized match-paired controlled trial aim ed to evaluate the impact of implant platform diameter on marginal bone level around implants restored according to the platform switching ( PS ) concept . MATERIAL AND METHODS A total of 24 implants were examined in 12 patients . All patients received two adjacent implants inserted at the crestal level : 4.3 mm ( control group ) and 4.8 mm ( test group ) in diameter . Mesio-distal implant position was r and omly performed . According to the PS concept , for restoration , a 3.8 and 4.3 mm diameter abutment was used , respectively in the control and test groups , result ing , in both groups , with 0.25 mm of implant/abutment mismatching . Implant restorations were splinted . Eighteen months after final restoration , periapical st and ardized digital radiographs were taken to evaluate marginal bone level alterations after loading . The Wilcoxon Signed-Rank Test was selected to identify differences between groups . RESULTS At the last follow-up , control implants exhibited a mean bone loss value of 1.10 mm ( SD : 0.47 mm ) ; the test group showed a mean value of 1.09 mm ( SD : 0.08 mm ) . No statistically significant differences were found between test and control groups . CONCLUSIONS Within the limits of this study , the present results suggest that bone resorption is mostly related to biologic ( biologic width re-establishment ) rather than to biomechanical factors ( implant platform diameter ) . Furthermore long-term studies with a wider sample size are needed to confirm the platform diameter influence on hard tissue response around implants restored according to the PS concept PURPOSE Submerged and nonsubmerged ITI solid-screw titanium implants were followed retrospectively from 1989 to 1993 and prospect ively from 1994 on to analyze long-term prognosis in partially and fully edentulous patients . MATERIAL AND METHODS A total of 468 implants were consecutively inserted in 191 patients from 1989 to 1998 . Two hundred twenty-eight successfully integrated fixed-restoration implants and 238 with removable restorations were restored following a healing period of 4 to 6 months ( 9 months in sinus floor elevation sites ) . From 1994 on all implants inserted were documented annually up to 9 years . During examination the clinical status of the implants was analyzed and evaluated according to predefined criteria of success and this allowed the calculation of 10-year cumulative survival and success rates for 468 implants . RESULTS Two implants ( 0.43 % ) did not successfully integrate during the healing period , and 8 implants ( 1.7 % ) were classified as failures during follow-up ( 1 late failure under load , 7 with a progressive bone loss from 1 to 3 threads ) . Including 68 implants in subjects who dropped out ( with a dropout rate of 14.4 % ) , the 10-year cumulative survival and success rates were 99.2 % and 96.4 % , respectively . DISCUSSION Over the course of this long-term study , osseointegrated implants , once used as a last possible solution , became nearly st and ard in cases of single-tooth implants because of the high rate of long-term success . Life table analysis not only determines whether an implant is functioning , it also makes a statement about its clinical status according to strict success criteria . CONCLUSION The study demonstrated that ITI solid-screw titanium implants achieved success rates above 95 % in a clinical center for an observation period of up to 10 years BACKGROUND Today , implants are placed using both non-submerged and submerged approaches , and in 1- and 2-piece configurations . Previous work has demonstrated that peri-implant crestal bone reactions differ radiographically under such conditions and are dependent on a rough/smooth implant border in 1-piece implants and on the location of the interface ( microgap ) between the implant and abutment/restoration in 2-piece configurations . The purpose of this investigation was to examine histometrically crestal bone changes around unloaded non-submerged and submerged 1- and 2-piece titanium implants in a side-by-side comparison . METHODS A total of 59 titanium implants were r and omly placed in edentulous m and ibular areas of 5 foxhounds , forming 6 different implant subgroups ( types A-F ) . In general , all implants had a relatively smooth , machined coronal portion as well as a rough , s and blasted and acid-etched ( SLA ) apical portion . Implant types A-C were placed in a non-submerged approach , while types D-F were inserted in a submerged fashion . Type A and B implants were 1-piece implants with the rough/smooth border ( r/s ) at the alveolar crest ( type A ) or 1.0 mm below ( type B ) . Type C implants had an abutment placed at the time of surgery with the interface located at the bone crest level . In the submerged group , types D-F , the interface was located either at the bone crest level ( type D ) , 1 mm above ( type E ) , or 1 mm below ( type F ) . Three months after implant placement , abutment connection was performed in the submerged implant groups . At 6 months , all animals were sacrificed . Non-decalcified histology was analyzed by evaluating peri-implant crestal bone levels . RESULTS For types A and B Output:

No significant difference in CBL was found around submerged and nonsubmerged dental implants

MS2_1shot488

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND The goal of our study was to measure the effectiveness of a home-based intervention for prevention of low birth weight with 154 high-risk , low-income black women attending a prenatal clinic in Clevel and . METHODS Based on previous research , risk was defined by clinic registration between the 17th and 28th weeks of gestation , low family functioning score , and experience of at least one stressful life event prior to registration . Optional factors included being a smoker , a low maternal weight-height ratio , being age 27 or older , and a previous premature birth . A 21-item family function screen previously vali date d in a similar population was the primary determinant of psychosocial risk . Low birth weight was defined as weight less than 2,500 g regardless of gestational age . RESULTS There was no decrease in the rate of low birth weight for women who received four home visits focusing on smoking , drug and nutrition education , support , and links with community services , compared to women who received no visits . The number of prenatal visits was significantly higher in the intervention group , but an increased number of prenatal visits did not correlate with a reduced rate of low birth weight . Despite previous research , the family function screen was not an effective predictor of low birth weight in our study . A revised equation involving a history of previous premature birth , smoking , and a low maternal weight-height ratio did predict low birth weight . CONCLUSIONS These findings question the utility of short-term psychosocial interventions for influencing low birth-weight rates in low-income black clinic population s. The family function screen was not cross vali date d. Integration of any psychosocial intervention with the routine prenatal care occurring in the obstetrical clinic is suggested for future research The authors investigated a large number of stressors and measures of psychological distress in a multicenter , prospect i ve cohort study of spontaneous preterm birth among 5,337 Montreal (Canada)-area women who delivered from October 1999 to April 2004 . In addition , a nested case-control analysis ( 207 cases , 444 controls ) was used to explore potential biologic pathways by analyzing maternal plasma corticotrophin-releasing hormone ( CRH ) , placental histopathology , and ( in a subset ) maternal hair cortisol . Among the large number of stress and distress measures studied , only pregnancy-related anxiety was consistently and independently associated with spontaneous preterm birth ( for values above the median , adjusted odds ratio = 1.8 ( 95 % confidence interval : 1.3 , 2.4 ) ) , with a dose-response relation across quartiles . The maternal plasma CRH concentration was significantly higher in cases than in controls in crude analyses but not after adjustment ( for concentrations above the median , adjusted odds ratio = 1.1 ( 95 % confidence interval : 0.8 , 1.6 ) ) . In the subgroup ( n = 117 ) of participants with a sufficient maternal hair sample , hair cortisol was positively associated with gestational age . Neither maternal plasma CRH , hair cortisol , nor placental histopathologic features of infection/inflammation , infa rct ion , or maternal vasculopathy were significantly associated with pregnancy-related anxiety or any other stress or distress measure . The biologic pathways underlying stress-induced preterm birth remain poorly understood This study investigates the relationship between adverse pregnancy outcomes in high-risk African American women in Washington , DC and sociodemographic risk factors , behavioral risk factors , and the most common and interrelated medical conditions occurring during pregnancy : diabetes , hypertension , preeclampsia , and Body Mass Index ( BMI ) . Data are from a r and omized controlled trial conducted in 6 prenatal clinics . Women in their 1st or 2nd trimester were screened for behavioral risks ( smoking , environmental tobacco smoke exposure , depression , and intimate partner violence ) and demographic eligibility . 1,044 were eligible , interviewed and followed through their pregnancies . Classification and Regression Trees ( CART ) methodology was used to : ( 1 ) explore the relationship between medical and behavioral risks ( reported at enrollment ) , sociodemographic factors and pregnancy outcomes ; ( 2 ) identify the relative importance of various predictors of adverse pregnancy outcomes ; and ( 3 ) characterize women at the highest risk of poor pregnancy outcomes . The strongest predictors of poor outcomes were prepregnancy BMI , preconceptional diabetes , employment status , intimate partner violence , and depression . In CART analysis , preeclampsia was the first splitter for low birthweight ; preconceptional diabetes was the first splitter for preterm birth ( PTB ) and neonatal intensive care admission ; BMI was the first splitter for very PTB , large for gestational age , Cesarean section and perinatal death ; employment was the first splitter for miscarriage . Preconceptional factors strongly influence pregnancy outcomes . For many of these women , the high risks they brought into pregnancy were more likely to impact their pregnancy outcomes than events during pregnancy Prenatal psychosocial predictors of infant birth weight and length of gestation were investigated in a prospect i ve study of 120 Hispanic and 110 White pregnant women . Hypotheses specifying that personal re sources ( mastery , self-esteem , optimism ) , prenatal stress ( state and pregnancy anxiety ) , and sociocultural factors ( income , education , ethnicity ) would have different effects on birth outcomes were tested using structural equation modeling . Results confirmed that women with stronger re sources had higher birth weight babies ( beta = .21 ) , whereas those reporting more stress had shorter gestations ( beta = -.20 ) . Re sources were also associated with lower stress ( beta = -.67 ) , being married , being White , having higher income and education , and giving birth for the first time . There was no evidence that re sources buffered the effects of stress . The importance of personal re sources in pregnancy is highlighted along with implication s for underst and ing the etiology of adverse birth outcomes Background : The aim of our study was to evaluate how sociodemographic factors , psychosocial adaptation to pregnancy and well-being levels are associated with the onset of preterm uterine contractions allowing symptomatic preterm labor . Methods : In a prospect i ve case-control design , 51 consecutive women admitted for threatened preterm labor were enrolled . The patients received st and ard care . The day before discharge , once contractions had been stopped , the patients were administered 2 question naires : the Prenatal Self-Evaluation Question naire of Lederman and the Psychological Well-Being Scales . Controls were enrolled among asymptomatic , healthy women attending routine prenatal care . They were matched for parity and gestational age . Results : Gestational age at inclusion ranged from 25 to 34 weeks . Fourteen cases and 4 controls delivered preterm . Cases were less educated than controls , showed a lower acceptance of pregnancy and worse relationship with others , namely with the husb and , compared to controls . They also displayed a reduced environmental mastery . Conclusion : Having a low education , poor relationship with others , including the husb and , and impaired coping skills appeared to be independent risk factors for the development of symptomatic preterm labor in urbanized women OBJECTIVE Selective serotonin reuptake inhibitor ( SSRI ) use during pregnancy incurs a low absolute risk for major malformations ; however , other adverse outcomes have been reported . Major depression also affects reproductive outcomes . This study examined whether 1 ) minor physical anomalies , 2 ) maternal weight gain and infant birth weight , 3 ) preterm birth , and 4 ) neonatal adaptation are affected by SSRI or depression exposure . METHOD This prospect i ve observational investigation included maternal assessment s at 20 , 30 , and 36 weeks of gestation . Neonatal outcomes were obtained by blinded review of delivery records and infant examinations . Pregnant women ( N=238 ) were categorized into three mutually exclusive exposure groups : 1 ) no SSRI , no depression ( N=131 ) ; 2 ) SSRI exposure ( N=71 ) , either continuous ( N=48 ) or partial ( N=23 ) ; and 3 ) major depressive disorder ( N=36 ) , either continuous ( N=14 ) or partial ( N=22 ) . The mean depressive symptom level of the group with continuous depression and no SSRI exposure was significantly greater than for all other groups , demonstrating the expected treatment effect of SSRIs . Main outcomes were minor physical anomalies , maternal weight gain , infant birth weight , pregnancy duration , and neonatal characteristics . RESULTS Infants exposed to either SSRIs or depression continuously across gestation were more likely to be born preterm than infants with partial or no exposure . Neither SSRI nor depression exposure increased risk for minor physical anomalies or reduced maternal weight gain . Mean infant birth weights were equivalent . Other neonatal outcomes were similar , except 5-minute Apgar scores . CONCLUSIONS For depressed pregnant women , both continuous SSRI exposure and continuous untreated depression were associated with preterm birth rates exceeding 20 % BACKGROUND The impact of prenatal depression on pregnancy outcomes is largely unknown . METHODS We conducted a population -based prospect i ve cohort study among pregnant women of the Kaiser Permanente Medical Care Program to examine the impact of prenatal depression on the risk of preterm delivery . We interviewed pregnant women in their early pregnancy . Women 's depressive symptoms were ascertained using the st and ard Center for Epidemiological Studies Depression Scale ( CESD ) . The presence of significant prenatal depressive symptoms and severe depressive symptoms was determined by CESD scores > or = 16 and > or = 22 , respectively . RESULTS Among the 791 participants who answered CESD questions and delivered a live birth , after controlling for potential confounders using the Cox proportional hazard regression , women with CESD scores > or = 16 had almost twice the risk of preterm delivery compared with women without depressive symptoms : adjusted hazard ratio ( aHR ) = 1.9 , 95 % confidence interval ( CI ) 1.0 - 3.7 . The risk of preterm delivery increased with increasing severity of depression : aHR = 1.6 ( CI 0.7 - 3.6 ) for CESD 16 - 21 and aHR = 2.2 ( CI 1.1 - 4.7 ) for CESD > or = 22 . The risk of preterm delivery associated with prenatal depression appears to be exacerbated by low educational level , a history of fertility problems and the presence of obesity and stressful events . The observed associations were not confounded by the use of antidepressants , although some of the associations did not reach statistical significance . CONCLUSIONS Our findings show that pregnant women with depressive symptoms are at increased risk of preterm delivery and , in addition , provide preliminary evidence that social and reproductive risk factors as well as obesity and stressful events may exacerbate the effect Objective : The high rate of preterm births is an imposing public health issue in the United States . Past research has suggested that prenatal stress , anxiety , and elevated levels of maternal plasma corticotropin-releasing hormone ( CRH ) are associated with preterm delivery in humans and animals . Studies to date have not examined all three variables together ; that is the objective of this paper . Methods : Data from 282 pregnant women were analyzed to investigate the effect of maternal prenatal anxiety and CRH on the length of gestation . It was hypothesized that at both 18 to 20 weeks ( Time 1 ) and 28 to 30 weeks gestation ( Time 2 ) , CRH and maternal prenatal anxiety would be negatively associated with gestational age at delivery . CRH was also expected to mediate the relationship between maternal prenatal anxiety and gestational age at delivery . Results : Findings supported the mediation hypothesis at Time 2 , indicating that women with high CRH levels and high maternal prenatal anxiety at 28 to 30 weeks gestation delivered earlier than women with lower CRH levels and maternal prenatal anxiety . Women who delivered preterm had significantly higher rates of CRH at both 18 to 20 weeks gestation and 28 to 30 weeks gestation ( p < .001 ) compared with women who delivered term . Conclusions : These findings are the first to link both psychosocial and neuroendocrine factors to birth outcomes in a prospect i ve design . ANOVA = analysis of variance ; BIPS = Behavior in Pregnancy Study ; CRH = corticotropin-releasing hormone ; HPA = hypothalamic-pituitary-adrenal axis ; SNS = sympathetic nervous system OBJECTIVE The aim was to test a model of the influence of maternal prenatal psychosocial stress on birth outcomes after controlling for biomedical risk . STUDY DESIGN In a prospect i ve study a sociodemographically homogeneous sample of 90 women was assessed during the third trimester with st and ard , reliable question naires that measured episodic and chronic stress , strain ( response to stress ) , and pregnancy-related anxiety . Birth outcomes included infant birth weight , gestational age at birth , and intrapartum complications . Parity and biomedical ( antepartum ) risk was also coded . Bivariate and multivariate analyses were performed after controlling for the effects of biomedical risk factors . RESULTS Independent of biomedical risk , each unit increase of prenatal life event stress ( from a possible sample range of 14.7 units ) was associated with a 55.03 gm decrease in infant birth weight and with a significant increase in the likelihood of low birth weight ( odds ratio 1.32 ) , and each unit increase of prenatal pregnancy anxiety ( from a possible sample range of 5 units ) was associated with a 3-day decrease in gestational age at birth . CONCLUSION Independent of biomedical risk , maternal prenatal stress factors are significantly associated with infant birth weight and with gestational age at birth Objectives : This study examined associations between reported pregnancy Output:

There is strong evidence that antenatal distress during the pregnancy increases the likelihood of preterm birth . CONCLUSION Complex paths of significant interactions between depression , anxiety and stress , risk factors and preterm birth were indicated in both direct and indirect ways . The effects of pregnancy distress were associated with spontaneous but not with medically indicated preterm birth .

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***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND Calcitonin gene-related peptide ( CGRP ) is a vali date d target for the treatment of episodic migraine . Here we assess the safety , tolerability , and efficacy of TEV-48125 , a monoclonal anti-CGRP antibody , in the preventive treatment of high-frequency episodic migraine . METHODS In this multicentre , r and omised , double-blind , placebo-controlled , phase 2b study , we enrolled men and women ( aged 18 - 65 years ) from 62 sites in the USA who had migraine headaches 8 - 14 days per month . Using a r and omisation list generated by a central computerised system and an interactive web response system , we r and omly assigned patients ( 1:1:1 ; stratified by sex and use of concomitant preventive drugs ) after a 28 day run-in period to three 28 day treatment cycles of subcutaneous 225 mg TEV-48125 , 675 mg TEV-48125 , or placebo . Investigators , patients , and the funder were blinded to treatment allocation . Patients reported headache information daily using an electronic diary . Primary endpoints were change from baseline in migraine days during the third treatment cycle ( weeks 9 - 12 ) and safety and tolerability . The secondary endpoint was change relative to baseline in headache-days during weeks 9 - 12 . Efficacy endpoints were analysed for the intention-to-treat population . Safety and tolerability were analysed using descriptive statistics . This trial is registered at Clinical Trials.gov , number NCT02025556 . FINDINGS Between Jan 8 , 2014 , and Oct 15 , 2014 , we enrolled 297 participants : 104 were r and omly assigned to receive placebo , 95 to receive 225 mg TEV-48125 , and 96 to receive 675 mg TEV-48125 . The least square mean ( LSM ) change in number of migraine-days from baseline to weeks 9 - 12 was -3.46 days ( SD 5.40 ) in the placebo group , -6.27 days ( 5.38 ) in the 225 mg dose group , and -6.09 days ( 5.22 ) in the 675 mg dose group . The LSM difference in the reduction of migraine-days between the placebo and 225 mg dose groups was -2.81 days ( 95 % CI -4.07 to -1.55 ; p<0.0001 ) , whereas the difference between the placebo and 675 mg dose group was -2.64 days ( -3.90 to -1.38 ; p<0.0001 ) . LSM differences in the reduction of headache-days were -2.63 days ( -3.91 to -1.34 ; p<0.0001 ) between the placebo group and 225 mg dose group and -2.58 days ( -3.87 to 1.30 ; p < 0.0001 ) between the placebo group and the 675 mg dose group . Adverse events occurred in 58 ( 56 % ) patients in the placebo group , 44 ( 46 % ) patients in the 225 mg dose group , and 57 ( 59 % ) patients in the 675 mg dose group ; moderate or severe adverse events were reported for 29 ( 27 % ) patients , 24 ( 25 % ) patients , and 26 ( 27 % ) patients , respectively . INTERPRETATION TEV-48125 , at doses of 225 mg and 675 mg given once every 28 days for 12 weeks , was safe , well tolerated , and effective as a preventive treatment of high-frequency episodic migraine , thus supporting advancement of the clinical development programme to phase 3 clinical trials . FUNDING Teva Pharmaceuticals BACKGROUND Benefits of calcitonin-gene related peptide ( CGRP ) inhibition have not been established in chronic migraine . Here we assess the safety , tolerability , and efficacy of two doses of TEV-48125 , a monoclonal anti-CGRP antibody , in the preventive treatment of chronic migraine . METHODS In this multicentre , r and omised , double-blind , double-dummy , placebo-controlled , parallel-group phase 2b study , we enrolled men and women ( aged 18 - 65 years ) from 62 sites in the USA who had chronic migraine . Using a r and omisation list generated by a central computerised system and an interactive web response system , we r and omly assigned patients ( 1:1:1 , stratified by sex and use of concomitant preventive drugs ) to three 28-day treatment cycles of subcutaneous TEV-48125 675/225 mg ( 675 mg in the first treatment cycle and 225 mg in the second and third treatment cycles ) , TEV-48125 900 mg ( 900 mg in all three treatment cycles ) , or placebo . Investigators , patients , and the funder were blinded to treatment allocation . Daily headache information was captured using an electronic diary . Primary endpoints were change from baseline in the number of headache-hours during the third treatment cycle ( weeks 9 - 12 ) and safety and tolerability during the study . Secondary endpoint was change in the number of moderate or severe headache-days in weeks 9 - 12 relative to baseline . Efficacy endpoints were analysed for the intention-to-treat population . Safety and tolerability were analysed using descriptive statistics . This trial is registered with Clinical Trials.gov , number , NCT02021773 . FINDINGS Between Jan 8 , 2014 , and Aug 27 , 2014 , we enrolled 264 participants : 89 were r and omly assigned to receive placebo , 88 to receive 675/225 mg TEV-48125 , and 87 to receive 900 mg TEV-48125 . The mean change from baseline in number of headache-hours during weeks 9 - 12 was -59.84 h ( SD 80.38 ) in the 675/225 mg group and -67.51 h ( 79.37 ) in the 900 mg group , compared with -37.10 h ( 79.44 ) in the placebo group . The least square mean difference in the reduction of headache-hours between the placebo and 675/225 mg dose groups was -22.74 h ( 95 % CI -44.28 to -1.21 ; p=0.0386 ) , whereas the difference between placebo and 900 mg dose groups was -30.41 h ( -51.88 to -8.95 ; p=0.0057 ) . Adverse events were reported by 36 ( 40 % ) patients in the placebo group , 47 ( 53 % ) patients in the 675/225 mg dose group , and 41 ( 47 % ) patients in the 900 mg dose group , whereas treatment-related adverse events were recorded in 15 ( 17 % ) patients , 25 ( 29 % ) patients , and 28 ( 32 % ) patients , respectively . The most common adverse events were mild injection-site pain and pruritus . Four ( 1 % ) patients had serious non-treatment-related adverse events ( one patient in the placebo group , one patient in the 675/225 mg group , and two patients in the 900 mg group ) ; no treatment-related adverse events were serious and there were no relevant changes in blood pressure or other vital signs . INTERPRETATION TEV-48125 given by subcutaneous injection every 28 days seems to be tolerable and effective , thus supporting the further development of TEV-48125 for the preventive treatment of chronic migraine in a phase 3 trial . FUNDING Teva Pharmaceuticals Background Calcitonin gene-related peptide plays an important role in migraine pathophysiology . Erenumab , a human monoclonal antibody that inhibits the calcitonin gene-related peptide receptor , is being evaluated for migraine prevention . Methods In this r and omized , double-blind , placebo-controlled , phase 3 study , 577 adults with episodic migraine were r and omized to placebo or 70 mg erenumab ; 570 patients were included in efficacy analyses . Primary endpoint was change in monthly migraine days . Secondary endpoints were ≥50 % reduction in monthly migraine days , change in acute migraine-specific medication treatment days , and ≥5-point reduction in Physical Impairment and Impact on Everyday Activities domain scores measured by the Migraine Physical Function Impact Diary . All endpoints assessed change from baseline at month 3 . Results Patients receiving erenumab experienced −2.9 days change in monthly migraine days , compared with −1.8 days for placebo , least-squares mean ( 95 % CI ) treatment difference of −1.0 ( −1.6 , −0.5 ) ( p < 0.001 ) . A ≥ 50 % reduction in monthly migraine days was achieved by 39.7 % ( erenumab ) and 29.5 % ( placebo ) of patients ( OR:1.59 ( 95 % CI : 1.12 , 2.27 ) ( p = 0.010 ) . Migraine-specific medication treatment days were reduced by −1.2 ( erenumab ) and −0.6 ( placebo ) days , a treatment difference of −0.6 ( −1.0 , −0.2 ) ( p = 0.002 ) . The ≥5-point reduction rates in Migraine Physical Function Impact Diary – Physical Impairment were 33.0 % and 27.1 % ( OR:1.33 ( 0.92 , 1.90 ) ( p = 0.13 ) and in Migraine Physical Function Impact Diary – Everyday Activities were 40.4 % and 35.8 % ( OR:1.22 ( 0.87 , 1.71 ) ( p = 0.26 ) . Safety and adverse event profiles of erenumab were similar to placebo . Most frequent adverse events were upper respiratory tract infection , injection site pain , and nasopharyngitis . Conclusions As a preventive treatment of episodic migraine , erenumab at a dosage of 70 mg monthly significantly reduced migraine frequency and acute migraine-specific medication use . ( Funded by Amgen ) . Trial registration Clinical Trials.gov , NCT02483585 Importance Galcanezumab ( LY2951742 ) , a monoclonal antibody against calcitonin gene-related peptide ( CGRP ) , is one of a novel class of new medicines for migraine prevention . Objective To assess whether at least 1 dose of galcanezumab was superior to placebo for episodic migraine prevention . Design , Setting , and Participants A r and omized clinical trial was conducted in the United States ( July 7 , 2014 , to August 19 , 2015 ) in clinics of 37 licensed physicians with a specialty including , but not limited to , psychiatry , neurology , internal medicine , and primary care . Subcutaneous injections of galcanezumab , 5 , 50 , 120 , or 300 mg , or placebo were given monthly during the 3-month treatment period . A total of 936 patients were assessed ; 526 did not meet study entry or baseline criteria and 410 patients were r and omly assigned to receive placebo or galcanezumab . Analyses were conducted on an intent-to-treat population , which included all patients who were r and omized and received at least 1 dose of study drug . Interventions Short-term migraine treatments were allowed as needed except for opioids or barbiturates . Main Outcomes and Measures To determine if at least 1 of the 4 doses of galcanezumab tested was superior to placebo for migraine prevention measured by the mean change from baseline in the number of migraine headache days 9 weeks to 12 weeks after r and omization . Results Of the 936 patients assessed , 410 met entry criteria ( aged 18 - 65 years with 4 - 14 migraine headache days per month and migraine onset prior to age 50 years ) and were r and omized to receive placebo or galcanezumab . For the primary end point , galcanezumab , 120 mg , significantly reduced migraine headache days compared with placebo ( 99.6 % posterior probability −4.8 days ; 90 % BCI , −5.4 to −4.2 days vs 95 % superiority threshold [ Bayesian analysis ] −3.7 days ; 90 % BCI , −4.1 to −3.2 days ) . Adverse events reported by 5 % or more of patients in at least 1 galcanezumab dose group and more frequently than placebo included injection-site pain , upper respiratory tract infection , nasopharyngitis , dysmenorrhea , and nausea . Conclusions and Relevance Monthly subcutaneous injections of galcanezumab , both 120 mg and 300 mg , demonstrated efficacy ( repeated- measures analysis ) for the preventive treatment of migraine and support further development in larger phase 3 studies . All dosages were safe and well tolerated for the preventive treatment of episodic Output:

The current body of evidence reveals that CGRP mAb is an effective and safe preventive treatment for episodic migraine

MS2_1shot490

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Objectives —To reduce fires and fire related injuries by increasing the prevalence of functioning smoke alarms in high risk households . Setting —The programme was delivered in an inner London area with above average material deprivation and below average smoke alarm ownership . The target population included low income and rental households and households with elderly persons or young children . Methods —Forty wards , averaging 4000 households each , were r and omised to intervention or control status . Free smoke alarms and fire safety information were distributed in intervention wards by community groups and workers as part of routine activities and by paid workers who visited target neighbourhoods . Recipients provided data on household age distribution and housing tenure . Programme costs were documented from a societal perspective . Data are being collected on smoke alarm ownership and function , and on fires and related injuries and their costs . Results —Community and paid workers distributed 20 050 smoke alarms , potentially sufficient to increase smoke alarm ownership by 50 % in intervention wards . Compared with the total study population , recipients included greater proportions of low income and rental households and households including children under 5 years or adults aged 65 and older . Total programme costs were £ 145 087 . Conclusions —It is possible to implement a large scale smoke alarm giveaway programme targeted to high risk households in a densely populated , multicultural , material ly deprived community . The programme 's effects on the prevalence of installed and functioning alarms and the incidence of fires and fire related injuries , and its cost effectiveness , are being evaluated as a r and omised controlled trial A prospect i ve study was design ed to evaluate the effects of education on the incidence of pediatric scald burns . Demographic data from our Trauma Registry identified the Zip code area of greatest risk . Eighty of 121 families with children in a large rental property were chosen r and omly for the education program . Twenty of these families also had an anti-scald device installed in the bathtub faucet ; all had two or more children under age 5 years . Families were surveyed before and after intervention . Safety knowledge improved post-education as judged by correct survey responses . Although 90 % of the families had water heaters set at " warm " ( < or = 120 degrees F ) , the actual temperature at the tap was above 130 degrees F in 71 % . The anti-scald devices did work , but at 9 months all but one had been removed because of sediment buildup , which prevented water flow . In the year of the study , the number of scald burns from the target Zip code area decreased from 15 to 12 . This was a pilot project for programs that can test public response to general safety education . An anti-scald device in conjunction with education works well in theory , but a better device needs to be engineered . In view of discrepancies between water heater setting s and tap water temperature , housing authorities could play a vital role in implementing safety measures Abstract Objective : To assess the effectiveness of safety advice at child health surveillance consultations , provision of low cost safety equipment to families receiving means tested state benefits , home safety checks , and first aid training on frequency and severity of unintentional injuries in children at home . Design : Cluster r and omised controlled trial . Setting : 36 general practice s in Nottingham . Subjects : All children aged 3 - 12 months registered with participating practice s. Interventions : A package of safety advice at child health surveillance consultations at 6 - 9 , 12 - 15 , and 18 - 24 months;provision of low cost safety equipment to families on means tested state benefits ; and home safety checks and first aid training by health visitors . Outcome measures : Primary outcomes measures were frequency and severity of medically attended injuries . Secondary outcome measures were self reported safety practice s , possession and use of safety equipment , knowledge and confidence in dealing with first aid , and perceptions of risk of injury and risk of hazards assessed by postal question naire at baseline and follow up at 25 months . Results : At baseline , both groups had similar risk factors for injury , sociodemographic characteristics , safety practice s , possession and use of safety equipment , knowledge and confidence in dealing with first aid , and perceptions of risk . No significant difference was found in frequency of at least one medically attended injury ( odds ratio 0.97 , 95 % confidence interval 0.72 to1.30 ) , at least one attendance at an accident and emergency department for injury ( , 0.76 to 1.37 ) , at least one primary care attendance for injury ( 0.75 , 0.48 to 1.17 ) , or at least one hospital admission for injury ( 0.69 , 0.42 to 1.12 ) . No significant difference in the secondary outcome measures was found between the intervention and control groups . Conclusions : The intervention package was not effective in reducing the frequency of minor unintentional injuries in children at home , and larger trials are required to assess the effect on more severe injuries Abstract Objective : To assess effectiveness of general practitioner advice about child safety , and provision of low cost safety equipment to low income families , on use of safety equipment and safe practice s at home . Design : R and omised , unblinded , controlled trial with initial assessment and six week follow up by telephone survey . Twenty families from intervention and control groups were r and omly selected for a home visit to assess validity of responses to second survey . Setting : A general practice in Nottingham . Subjects : 98 % ( 165/169 ) of families with children aged under 5 years registered with the practice . Interventions : General practitioner safety advice plus , for families receiving means tested state benefits , access to safety equipment at low cost . Control families received usual care . Main outcome measures : Possession and use of safety equipment and safe practice s at home . Results : Before intervention , the two groups differed only in possession of fireguards . After intervention , significantly more families in intervention group used fireguards ( relative risk 1.89 , 95 % confidence interval 1.18 to 2.94 ) , smoke alarms ( 1.14 , 1.04 to 1.25 ) , socket covers ( 1.27 , 1.10 to 1.48 ) , locks on cupboards for storing cleaning material s ( 1.38 , 1.02 to 1.88 ) , and door slam devices ( 3.60 , 2.17 to 5.97 ) . Also , significantly more families in intervention group showed very safe practice in storage of sharp objects ( 1.98 , 1.38 to 2.83 ) , storage of medicines ( 1.15 , 1.03 to 1.28 ) , window safety ( 1.30 , 1.06 to 1.58 ) , fireplace safety ( 1.84 , 1.34 to 2.54 ) , socket safety ( 1.77 , 1.37 to 2.28 ) , smoke alarm safety ( 1.11 , 1.01 to 1.22 ) , and door slam safety ( 7.00 , 3.15 to 15.6 ) . Stratifying results by receipt of state benefits showed that intervention was at least as effective in families receiving benefits as others . Conclusions : General practitioner advice , coupled with access to low cost equipment for low income families , increased use of safety equipment and other safe practice s. These findings are encouraging for provision of injury prevention in primary care . Key messages We assessed the effectiveness of general practitioner advice about child safety , and provision of low cost safety equipment to low income families , on safe practice s at home The intervention increased safe behaviour and use of safety equipment The intervention was equally effective in families receiving means tested benefits as in those not receiving benefits The effectiveness of this intervention should be evaluated over longer periods , in other practice s , and when delivered by other members of the primary healthcare In King County , Washington , during 1985 - 1986 , 98 children aged less than 15 years involved in pedestrian-motor vehicle collisions result ing in death or injuries severe enough to require hospitalization were identified through the Trauma Registry at the Regional Trauma Center and the Medical Examiner 's Office . Two age- and sex-matched controls were selected for each case , one through r and om digit dialing and the other from children undergoing appendectomy . Various environmental and traffic characteristics were ascertained from visits to the neighborhoods of all subjects . Children living in multifamily dwellings had a risk for injury that was 5.5 times greater than children living in single family homes ( 95 % confidence interval 2.5 - 12.3 ) . In general , areas with busier streets ( greater posted vehicle speeds and /or greater traffic volumes ) were associated with increased risk for pedestrian injuries . The lack of pedestrian crossing devices , crosswalks , or sidewalks , however , was not associated with an increased risk . When the analysis was restricted to the 23 cases injured in front of their homes and their controls , risks were not elevated for any of the street or traffic characteristics . The small size of the study and the lack of relevant information for many subjects limited our ability to adjust for the likely confounding influence of other household/environmental factors . Thus , these results should be viewed as suggestions for future investigations of the causes of childhood pedestrian injuries Abstract Objective : To apply a measure of exposure to injury risk for schoolchildren aged 11 - 14 across a population and to examine how risk factors vary with sex , age , and affluence . Design : Self completion question naire survey administered in schools in May 1990 . Setting : 24 schools in Newcastle upon Tyne . Subjects : 5334 pupils aged 11 - 14 , of whom 4637 ( 87 % ) completed the question naire . Results : Boys were exposed to greater risk than girls in journeys to places to play outdoors : they took longer trips and were more likely to ride bicycles ( relative risk 5.30 ( 95 % confidence interval 4.23 to 6.64 ) and less likely to travel by public transport or car . Younger pupils ( aged 11 - 12 ) were less exposed to traffic during journeys to and from school : their journeys were shorter , they were less likely to walk ( trip to school , relative risk 0.88 ( 0.83 to 0.94 ) , and they were more likely to travel by car ( trip to school , relative risk 1.33 ( 1.13 to 1.56 ) ) or school bus ( 1.33 ( 1.10 to 1.62 ) ) . Poorer children were exposed to greater risk than affluent children ( from families that owned a car and a telephone ) : they were less likely to travel to school by car ( relative risk 0.26 ( 0.20 to 0.33 ) ) or to be accompanied by an adult ( 0.39 ( 0.32 to 0.48 ) ) . Conclusion : Injury risk data can provide useful information on child injury prevention and can be used to identify priorities and target re sources for injury prevention on a citywide scale or for an individual school Objective —To evaluate the effectiveness of a skills training program in improving safe cycling behavior , knowledge , and attitudes in young children . Methods — Grade 4 children from six elementary schools in East York ( a borough of Metropolitan Toronto ) participated . The intervention — playground based instruction on bicycle h and ling skills by certified instructors — was r and omly allocated to three schools . Altogether 141 children participated : 73 in the intervention group and 68 in the control group , with follow up evaluations available on 117 ( 83 % ) . The primary outcome was safe cycling behavior ( straight line riding , coming to a complete stop , and shoulder checking before a left turn ) . A self report question naire collected data on knowledge and attitudes . Baseline assessment s were made in June , with follow up evaluations in September , 1995 . Results —The prevalence of safe cycling behaviors at follow up in the intervention and control groups respectively , were : straight line riding ( 90 % v 88 % ; p=0.782 ) , coming to a complete stop ( 90 % v 76 % ; p=0.225 ) , and shoulder checking ( 0 % v 2 % ; p=1.000 ) . Over time ( from baseline to follow up ) children in both groups were more likely to maintain straight line riding , less likely to ride on the sidewalk , and less likely to consider that a car had more right to the road . Conclusions —This brief skills training program was not effective in improving safe cycling behavior , knowledge , or attitudes among grade 4 children In a prospect i ve trial at two hospitals , 78 of 136 couples received a special 30-minute curriculum consisting of a lecture , a motion picture demonstrating the consequences of not using child car safety seats , and a question - and -answer session . Four to six months postpartum all parents were interviewed by telephone . When asked how their child rode during the most recent car trip , 96 % of parents who received the special curriculum said they used a crash-tested child car safety seat , compared with 78 % of those who had not received the curriculum . At hospital B , where parents reported demographic factors often associated with low compliance ( eg , lower income , low use of seat belts , lower educational level ) , compliance rose from 60 % before curriculum to 94 % after curriculum ( P<.01 ) . A car safety curriculum added to prenatal classes will increase parents ' use of child car safety seats . Obstetricians and those managing prenatal care should assume a role in educating expectant parents about child passenger safety . ( Obstet Gynecol 65:312 , 1985 HYPOTHESIS Young children can learn safety behavior in the public school system . These children will modify family seat belt use . SETTING DESIGN : This is a prospect i ve cohort analytic study conducted in a 50,000 square mile regionalized trauma center referral area . METHODS A school-based injury prevention program targeting kindergarten through second- grade ( K-2 ) students addressed four aspects of traffic safety : seat belt use , pedestrian and bicycle safety , school bus safety , and unsafe rides . After inservice instruction , teachers taught the program over a 10-week period . A simultaneous community traffic safety program was conducted through the media . Family seat belt use was monitored by blinded observation at six study schools and one control school . Income level Output:

The literature was not evenly spread across different injury types and did not reflect the burden of injury . There is a paucity of evidence relating to the prevention of child pedestrian injury . Without such evidence , it remains difficult for those involved in health promotion to know how to design and target interventions to address inequalities in child injury rates

MS2_1shot491

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: PURPOSE A multicenter phase II study to determine the activity and toxicity of Caelyx ( Doxil ; Sequus Pharmaceuticals Inc , Menlo Park , CA ) in patients with metastatic breast cancer . PATIENTS AND METHODS Seventy-one patients with stage IV breast cancer were treated with Caelyx at doses of 45 to 60 mg/m2 every 3 to 4 weeks for a maximum of six cycles . Twenty-eight patients had received prior chemotherapy with a nonanthracycline regimen . Fifty-two patients had disease at multiple sites . Hepatic and pulmonary disease were the predominant metastatic site in 50 patients . Response was assessable in 64 cases . RESULTS Sixteen patients achieved a partial response and a complete response ( overall response rate , 31 % ; ( 95 % confidence interval , 20 % to 43 % ) . Twenty patients ( 31 % ) had stable disease on treatment . Neutropenia > or = grade 3 occurred in 10 % of cycles ( 27 % of patients ) and mucositis > or = grade 3 in 10 % of cycles ( 32 % of patients ) . Significant alopecia was rare and routine prophylactic antiemetics were not required . At doses of 60 mg/m2 every 3 weeks , seven of 13 patients had > or = grade 3 skin toxicity ; overall , this toxicity complicated 25 % of treatment cycles . The incidence of > or = grade 3 skin toxicity was greatly reduced at doses of 45 mg/m2 every 4 weeks , occurring in five of 32 patients and affecting only 5 % of 126 treatment cycles . CONCLUSION Caelyx is an active agent in advanced breast cancer with a safety profile that differs markedly from nonliposomal doxorubicin . A regimen of 45 mg/m2 every 4 weeks was well tolerated in this cohort of women with advanced poor-prognosis breast cancer . The mild myelosuppression seen with this regimen would favor its use in combination chemotherapy Output:

We found that the most important side effects of PLD were skin toxicity and mucositis , but the proportion of patients who showed grade III and IV of these side effects was relatively low . On the other h and , the occurrence of cardiotoxicity , the most important problem with doxorubicin , was considerably reduced in patients treated with PLD . Although PLD has demonstrated a lower toxicity profile than conventional anthracyclines , it has also new side effects . However , it seems that the reduced cardiotoxicity of PLD has made it a more appropriate option in patients with MBC , especially in those with risk factors for cardiac diseases

MS2_1shot492

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: BACKGROUND Approximately 3,000 new cases of oral cancer are diagnosed each year in Canada . Most of these cases occur among older adults with a history of tobacco use or excessive alcohol consumption . Preventive interventions for oral cancer include counselling of patients to modify risk factors and screening to identify precancerous and early-stage lesions . This report presents evidence -based guidelines on the prevention of oral cancer and precancer among asymptomatic patients . METHODS Literature search es of the 1966 - 1999 MEDLINE and CANCERLIT data bases were completed using the major MeSH heading mouth neoplasms . References from articles and recommendations of organizations were also review ed . The evidence -based methods of the Canadian Task Force on Preventive Health Care were used to assess evidence and to develop guidelines . Advice from experts and other recommendations were taken into consideration . RESULTS In cohort and case-control studies , smoking cessation decreased the risk of oral cancer and precancer . R and omized controlled trials ( RCTs ) indicate counselling by trained health care professionals is effective in promoting smoking cessation . Although counselling has been effective for the reduction of excessive alcohol consumption in RCTs , no studies have examined whether alcohol reduction reduces the risk of oral cancer or precancer . The usefulness of general population screening is limited by the low prevalence and incidence of the disease , the potential for false-positive diagnoses and the poor compliance with screening and referral . There is no evidence that screening of the general population or high-risk groups leads to a reduction in mortality or morbidity from oral cancer . INTERPRETATION There is good evidence to specifically consider smoking cessation counselling in a periodic health examination ( grade A recommendation ) . For population screening , there is fair evidence to specifically exclude screening for oral cancer ( grade D recommendation ) . For opportunistic screening during periodic examinations , there is insufficient evidence to recommend inclusion or exclusion of screening for oral cancer ( grade C recommendation ) . For patients at high risk , annual examination by physician or dentist should be considered . Risk factors include tobacco use and excessive consumption of alcohol . These recommendations are similar to those made by the Canadian Task Force on the Periodic Health Examination in 1994 and by the U.S. Preventive Services Task Force in 1996 A r and omized intervention trial is in progress in Kerala , India , to evaluate the effectiveness of oral visual inspection by trained health workers ( HWs ) in the prevention of oral cancer . Fourteen health workers with college graduation as the basic qualification were trained in oral visual inspection to identify oral cancers and precancers among the participants of the screening trial and to refer them for further confirmation and management . The aim of the present study was to evaluate the reproducibility and validity of the screening test provided by the health worker against the reference oral visual findings of three physicians . A total of 2069 subjects who had already been examined were re-examined by the health workers and physicians . The sensitivity and the specificity of the oral visual inspection were 94.3 % and 99.3 % respectively . There was moderate agreement between the findings of the initial and the repeat mouth examinations carried out by the health workers , which were on average 6 months apart . There was almost perfect agreement ( kappa = 0.85 ) between the findings of the health workers and the physicians in identifying the different types of oral precancerous lesions . The findings of our study indicate that it is possible to train re source persons to perform the oral cancer screening test as accurately as doctors , although experience appears to be a crucial component of health workers ' accuracy . The efficacy of such an approach to reduce the incidence of and mortality from oral cancer , however , remains to be proven Oral cancer is caused by chewing and smoking of tobacco . To assess the feasibility of primary prevention of oral cancer , two cohorts were studied in base-line surveys and then followed up annually for 10-yr in Ernakulam district of Kerala state . The intervention cohort consisted of 12212 tobacco users aged 15 yr and over , who were exposed to a concentrated program of education against tobacco use . The control cohort was a non-concurrent cohort of 6075 tobacco users studied using similar methods but with a minimal amount of advice against tobacco use . The stoppage of tobacco use increased and the incidence rate of leukoplakia decreased significantly and substantially in the intervention cohort compared to the control cohort . The decrease in the incidence of leukoplakia was indicative of the decrease in the risk of oral cancer since the two were intimately related . This study demonstrated feasibility of primary prevention of oral cancer A cluster r and omized controlled oral cancer screening trial is on-going in the Triv and rum district , India , to evaluate the efficacy of screening in reducing oral cancer mortality . Subjects , aged 35 years and above , in 13 clusters in the Triv and rum district , India , were r and omized to the intervention ( screening ) group ( 7 clusters , 78969 subjects ) to receive three rounds of screening by oral visual inspection by trained health workers at 3-year intervals or to a control group ( 6 clusters , 74739 subjects ) . Two rounds of screening were completed between 1995 and 2002 during which 69896 ( 88.5 % ) subjects were screened at least once , and 59.7 % of the 4408 screen-positive subjects were further investigated . In the intervention group , 344404 person-years were accrued and 329326 person-years were in the control group . In the intervention group , 149 incident oral cancer cases and 65 deaths from oral cancer were observed , and 106 incident cases and 62 deaths from oral cancer were observed in the control group . The programme sensitivity for detection of oral precancerous lesions and cancer was 81.5 % and the programme specificity was 84.8 % ; the programme positive predictive value was 39.6 % . In the intervention group 37.6 % of the cases were in stages I-II , as opposed to 18.9 % in the control group . The 3 year survival rate was 57.5 % in the intervention and 38.8 % in the control group ( P<0.05 ) . The age st and ardized oral cancer mortality rates were 21.2/100000 person-years in the intervention and 21.3/100000 in the control group . After completing two rounds of screening , oral cancer mortality rates were similar in both study groups It is well established that most invasive oral cancers arise from precancerous lesions such as leukoplakia , erythroplakia and oral submucous fibrosis . One of the approaches for control of oral cancer is to detect oral precancerous lesions early in their development and prevent their malignant transformation to invasive cancer either by chemoprevention or by surgical excision of the lesions , with concurrent control of tobacco and alcohol use and other specific aetiological factors . However , the value of specific approaches such surgery in long-term control of lesions and prevention of malignant transformation is not known . We describe our experience with cold knife surgical excision of 59 cases of non-homogeneous leukoplakia of the oral cavity diagnosed in the context of a community-based oral cancer cluster r and omised oral cancer screening trial in Kerala , India . Two-thirds of these revealed dysplasia on histology . After a minimum follow-up of 12 months ( range 12 - 37 months ) after surgical excision , 44 ( 74.8 % ) were remaining disease free with no evidence of recurrent/new lesions ; during follow-up , three ( 5 % ) developed new luekoplakic lesions , and six ( 10.1 % ) developed recurrent lesions , while six ( 10.1 % ) could not be traced after treatment . There was no event of malignant change during follow-up . The proportion of subjects remaining with no evidence of disease at 3 years by Kaplan-Meier method of analysis was 62.1 % ( 95 % CI : 0.36 - 0.87 ) . Accrual and long-term follow-up of large number of surgically treated cases may provide valuable leads to management policies of oral leukoplakia , since , as of now , the added value of specific treatments over and above primary prevention by tobacco and alcohol control remains to be established The aim of the study was to evaluate dental health care workers ' ability to recognise oral cancer and pre-cancer from colour photographic slides . A set of 80 slides was prepared , 40 were negative ( normal mucosa or lesions with no malignant potential ) and 40 were positive ( cancer or potentially malignant lesions ) . The slides were arranged in r and om order and projected in a st and ard format . The performance was evaluated in terms of mean sensitivity , specificity , mean correct score and likelihood ratio . There were no significant differences between the three groups of dentists ( consultants , juniors hospital dentists and general dentists ) , all performed better than the auxiliaries . The chances of a consultant making a correct decision were 5.5 times better than for an auxiliary and 2.7 times better than for a junior hospital dentist . The slide show enables a comparison of health care workers to be made and may be useful for the evaluation , training and calibration of examiners for an oral cancer screening programme BACKGROUND A study group composed of research ers from across the United States undertook a study to evaluate the sensitivity and specificity of OralCDx ( OralScan Laboratories Inc. ) , a computer-assisted method of analysis of the oral brush biopsy , in the detection of precancerous and cancerous lesions of the oral mucosa . METHODS The study group conducted a multicenter double-blind study comparing results of OralCDx analysis with those of scalpel biopsy of suspicious oral lesions , as well as using OralCDx on oral lesions that appeared benign clinical ly . RESULTS In 945 patients , OralCDx independently detected every case of histologically confirmed oral dysplasia and carcinoma ( sensitivity = 100 percent , false-negative rate = 0 percent ) . Every OralCDx " positive " result was subsequently confirmed by histology as dysplasia or carcinoma . The specificity for the OralCDx " positive " result was 100 percent , while the specificity for the OralCDx " atypical " results was 92.9 percent . In 4.5 percent of clinical ly benign-appearing lesions that would not have received additional testing or attention other than clinical follow-up , OralCDx uncovered dysplasia or carcinoma ( statistical sensitivity > 96 percent , P < .05 , n = 131 ; statistical specificity for the OralCDx " positive " result > 97 percent and for the " atypical " result > 90 percent , P < .05 , n = 196 ) . CONCLUSIONS The authors propose that this multicenter trial demonstrates that OralCDx is a highly accurate method of detecting oral precancerous and cancerous lesions . OralCDx can aid in confirming the nature of apparently benign oral lesions and , more significantly , revealing those that are precancerous and cancerous when they are not clinical ly suspected of being so . All OralCDx " atypical " and " positive " results should be referred for scalpel biopsy and histology to completely characterize the lesion . CLINICAL IMPLICATION S Given the difficulty in clinical ly differentiating premalignant and malignant lesions from benign lesions with a similar appearance , OralCDx appears to determine the significance of an oral lesion definitively and detect innocuous-appearing oral cancers at early , curable stages BACKGROUND Oral cancer screening procedures are design ed to collectively allow early detection of cancers in a body area accessible to visual and physical examination , as well as to facilitate timely treatment , awareness , and the ongoing education of the public . METHODS A state fair was selected for this activity because of the availability of a r and om population compatible with meeting these goals . A total of 1,151 individuals participated in this free elective activity . RESULTS Of this number 4.17 % were deemed to have oral pathologic states necessitating professional intervention , and 1.82 % were clinical ly diagnosed as having potential dysplastic or precancerous lesions . No clinical oral cancer was detected in this population . Nevertheless , by virtue of screening and detecting clinical ly premalignant lesions , the screening test advanced the diagnosis of potential oral cancers . CONCLUSIONS The outcome adds support to oral cancer screening as a procedure applicable in reducing morbidity and mortality from oral cancers Oral cancer satisfies the criteria for a suitable disease for screening , and oral visual inspection is a suitable test for oral cancer screening . The efficacy of screening in reducing mortality from oral cancer has not yet been evaluated . The authors describe a cluster‐r and omized , controlled oral cancer screening trial in southern India and its early results The utilisation of primary health workers ( HWs ) for cancer control in developing countries has often been suggested , based on the experience of feasibility studies in India and Sri Lanka . We initiated a project in 1988 to evaluate the long-term feasibility of using trained HWs in secondary prevention of oral cancer , to bring about earlier detection of oral cancer in the communities served by them . Two hundred and eighty-two HWs attached to 14 primary health centres ( PHCs ) , serving approximately 0.92 million rural population in the northern half of Triv and rum district in Kerala , India , were trained in oral visual inspection to detect precancerous , malignant and other suspicious lesions of the oral cavity and refer them for confirmation and treatment . They were asked to examine subjects aged 35 years and above and to give person to person health education on tobacco in their target population . The HWs belonging to the PHCs serving approximately 1 million rural population in the southern half of Triv and rum district were not trained , and this region served Output:

Given the limitation of evidence and the potential method ological weakness in the included study , it is valid to say that there is no evidence to recommend inclusion or exclusion of screening programs for oral cancer using visual examination in the general population .

MS2_1shot493

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: INTRODUCTION The concept of sexually related personal distress is currently central to the diagnosis of all female sexual dysfunctions ( FSD ) . In the current study , we have focused on validating a slightly revised version of the Female Sexual Distress Scale ( FSDS ) , the FSDS-Revised ( FSDS-R ) , to enhance the sensitivity of the instrument with patients suffering from hypoactive sexual desire disorder ( HSDD ) . In addition , we have attempted to extend the validation generalizability of the scale by demonstrating that both instruments possess reliability and discriminative validity in premenopausal women with HSDD . AIM To assess the validity of the revised version of the FSDS , the FSDS-R , for measuring sexual distress in women with HSDD . METHODS A prospect i ve method ological study carried out at 27 centers in North America enrolled 296 women aged 18 - 50 years with HSDD , another female sexual dysfunction ( FSD ) , or no FSD . The subjects completed the FSDS-R at baseline , day 7 , and day 28 , with a 30-day recall at baseline and with a 7-day recall on days 7 and 28 . MAIN OUTCOME MEASURES Receiver operating characteristic ( ROC ) analyses of FSDS , FSDS-R , and FSDS-R item 13 were used for the differentiation of HSDD from no FSD , while intraclass correlation coefficient ( ICC ) was used to estimate test-retest reliability . Cronbach 's coefficient alpha was used to measure the internal consistency of the FSDS-R and Pearson 's correlation coefficient to assess FSDS , FSDS-R , and FSDS-R item 13 with different recall periods ( 7 and 30 days ) . RESULTS Mean total FSDS , FSDS-R , and FSDS-R item 13 scores with either recall period were significantly higher ( P < 0.0001 ) in women with FSD or HSDD than in women with no FSD , showing both tests had discriminant validity . ROC analysis confirmed these findings , while an ICC of > 0.74 showed the test-retest reliability of both scales , including FSDS-R item 13 alone , and Cronbach 's coefficient alpha of > 0.86 confirmed the internal consistency of both tests . CONCLUSIONS Consistent with the FSDS , the FSDS-R demonstrated good discriminant validity , high test-retest reliability , and a high degree of internal consistency in measuring sexually related personal distress in women with HSDD . FSDS-R item 13 alone also demonstrated good discriminant validity and test-retest reliability OBJECTIVE To examine the effect on pain and quality of life for women with all stages of endometriosis undergoing laparoscopic surgery compared with placebo surgery . DESIGN A r and omized , blinded , crossover study . SETTING A tertiary referral unit in a district general hospital . PATIENT(S ) Thirty-nine women with histologically proven endometriosis completed the 12-month study . INTERVENTION(S ) Women were r and omized to receive initially either a diagnostic procedure ( the delayed surgical group ) or full excisional surgery ( the immediate surgery group ) . After 6 months , repeat laparoscopy was performed , with removal of any pathology present . MAIN OUTCOME MEASURE(S ) The end points were changes from baseline values of visual analogue pain scores , vali date d quality -of-life instruments ( EQ-5D and SF-12 ) , and sexual activity question naire scores . Patients and assessors of outcomes were blinded to the treatment-group assignment . RESULT ( S ) Significantly more of the 39 women operated on according to protocol reported symptomatic improvement after excisional surgery than after placebo : 16 of 20 ( 80 % ) vs. 6 of 19 ( 32 % ) ; chi(2)(1 ) = 9.3 . Other aspects of quality of life were also significantly improved 6 months after excisional surgery but not after placebo . Progression of disease at second surgery was demonstrated for women having only an initial diagnostic procedure in 45 % of cases , with disease remaining static in 33 % and improving in 22 % of cases . Nonresponsiveness to surgery was reported in 20 % of cases . CONCLUSION ( S ) Laparoscopic excision of endometriosis is more effective than placebo at reducing pain and improving quality of life . Surgery is associated with a 30 % placebo response rate that is not dependent on severity of disease . Approximately 20 % of women do not report an improvement after surgery for endometriosis STUDY QUESTION Is there a difference between women with endometriosis who underwent laparoscopic surgery with bowel resection or without bowel resection regarding depressive symptoms , relational adjustment and sexual functioning ? SUMMARY ANSWER Radical surgery for endometriosis in both groups improved the levels of depression and sexual functioning , but only the bowel resection patients showed improvements in relationship satisfaction . WHAT IS KNOWN ALREADY ? : The frequent pain symptoms in endometriosis patients can have an impact on psychological issues , relationships and sexual functioning . There are no data available on depression and relationship adjustment after endometriosis surgery . Sexual dysfunction problems have been described after bowel resection for rectal cancer , but no data are available for endometriosis surgery . STUDY DESIGN , SIZE , DURATION This prospect i ve cohort study included 203 consecutive women operated at the Leuven University Fertility Center ( LUFC ) between 1 September 2006 and 30 September 2008 for moderate ( n = 67 ) or severe ( n = 136 ) endometriosis . The preoperative response rate was respectively 84 % in the bowel resection group and 79 % in the no bowel resection group . PARTICIPANTS , SETTING , METHODS The beck depression inventory ( BDI ) measured depression , the dyadic adjustment scale ( DAS ) measured relationship satisfaction and the short sexual functioning scale ( SSFS ) measured sexual functioning before and 6 , 12 and 18 months after women had laparoscopic surgery at the LUFC , a tertiary referral centre for fertility exploration , treatment and surgery . MAIN RESULTS AND THE ROLE OF CHANCE Both groups had better post-operative outcomes when compared with the preoperative assessment s. Mean BDI and DAS levels were comparable with the normal population . Overall assessment points , the bowel resection patients had better outcomes for DAS ( P < 0.05 ) and SSFS ' arousal ' ( P < 0.05 ) than the no bowel resection patients . At 6 months after the operation , when compared with the no bowel resection group , the bowel resection group reported lower mean levels of BDI ( P < 0.05 ) , a lower incidence of SSFS ' pain during intercourse ' and ' orgasm problems ' ( P < 0.05 ) , and a lower proportion of patients with severe orgasm problems ( P < 0.05 ) . The data show that radical but fertility sparing surgery , with or without bowel resection , for the treatment of endometriosis results in comparable and good psychological outcomes concerning depression levels , relationship satisfaction and sexual functioning . LIMITATIONS , REASONS FOR CAUTION Although the initial response rate was good , response dropped over time and was significantly higher for bowel resection patients compared with the no bowel resection patients ( P = 0.05 ) . A responder/non-responder analysis for the whole study population showed no significant differences concerning pain problems . This reduces the possible risk of ( positive ) bias in the results . WIDER IMPLICATION S OF THE FINDINGS Endometriosis is a complex condition and the focus should not be on a one-dimensional end-organ gynaecological outcome , but should take into account the role of psychological factors in pain-related outcome . To this end , more prospect i ve data are needed on sexual functioning and psychological outcomes BACKGROUND Among subjects with endometriosis and deep dyspareunia ( DD ) , those with endometriosis of the uterosacral ligament ( USLE ) have the most severe impairment of sexual function . This study examines the effect of laparoscopic excision of endometriosis on DD and quality of sex life . METHODS This observational cohort prospect i ve study included 68 women with endometriosis suffering DD ( intensity of pain > or= 6 on a 10-cm visual analogue scale ) . Patients underwent laparoscopic full excision of endometriosis . Following surgery , they were asked to use nonhormonal contraception devices . Before surgery , at 6- and at 12-month follow-up , patients answered a self-administered question naire based on the Sexual Satisfaction Subscale of the Derogatis Sexual Functioning Inventory . RESULTS At 6- and 12-month follow-up , women with and without USLE had significant improvement in DD . Subjects with USLE reported increased variety in sex life , increased frequency of intercourse , more satisfying orgasms with sex , relaxing more easily during sex and being more relaxed and fulfilled after sex . Similar improvements were observed among women without USLE ; however , for some variables statistical significance was not reached . CONCLUSIONS Surgical excision of endometriosis improves not only DD but also the quality of sex life INTRODUCTION Deep infiltrating endometriosis ( DIE ) is a form of endometriosis in which the lesion penetrates for more than 5 mm under the peritoneal surface . It is a chronic disease which can impair women 's sexual function . There is a growing body of evidence supporting combined surgical/medical treatment in the management of DIE . AIMS The aims of this article are to evaluate the impact of the laparoscopic full excision of endometriosis and postoperative combined oral contraceptives ( COC ) administration on sexual function in patients with DIE and to compare sexual function outcomes of women su bmi tted to intestinal resection and nodule excision . METHODS It is a prospect i ve cohort study in a tertiary care university hospital on 106 sexually active women , with histologically confirmed DIE , managed by laparoscopy and subsequent COC therapy for 6 months . Patients filled preoperatively and 6-month postoperatively a quality of sexual life question naire , the Sexual Health Outcomes in Women Question naire ( SHOW-Q ) and they ranked their symptom intensity using a 10-point visual analogue scale ( VAS ) . MAIN OUTCOME MEASURES Sexual function was measured through the SHOW-Q scores and pain symptoms through VAS scores . Intraoperative details , type of intervention and perioperative complications were noted . RESULTS Six months after surgery and postoperative COC treatment , a significant improvement was observed in the SHOW-Q domains of pelvic problem interference , sexual satisfaction and desire ( P<0.05 ) . Laparoscopic management of DIE did not change significantly the orgasm area of the sexual functioning ( P=0.7 ) . No significant difference was found in SHOW-Q scores between patients su bmi tted to intestinal resection and patients su bmi tted to intestinal nodule excision ( P>0.05 ) . CONCLUSIONS Sexual desire , satisfaction with sex and pelvic problem interference with intercourse are significantly improved after 6 months from laparoscopic excision of DIE combined with postoperative COC therapy . No difference in sexual outcomes was detected between patients su bmi tted to intestinal resection and nodule excision OBJECTIVE To identify prognostic factors for pain and endometrioma recurrence after complete laparoscopic excision of endometrioma(s ) . DESIGN Prospect i ve observational study . SETTING Tertiary care university hospital . PATIENT(S ) One-hundred sixty-six consecutive women affected by uni- or bilateral ovarian endometrioma(s ) . INTERVENTION(S ) Laparoscopic conservative treatment of endometriosis . MAIN OUTCOME MEASURE(S ) Patient demographic characteristics , surgical findings , and surgical results were prospect ively recorded . Postoperative follow-ups were carried out every 3 months to identify pain and /or endometrioma recurrence for a minimum of 3 years . RESULT ( S ) Dysmenorrheal , dyspareunia , and chronic pelvic pain recurred in 14.5 % , 6 % , and 5.4 % of women , respectively . Prior surgery for endometriosis , adhesion extension , and use of ovarian stimulation drugs ( OSD ) were unfavorable prognostic factors for pain symptoms . Ovarian endometrioma recurred in 9.6 % of cases ; negative factors were prior surgery for endometriosis , OSD , pelvic adhesions , and high American Society for Reproductive Medicine disease scores . Postoperative pregnancy showed a significant protective effect on pain and disease recurrences . CONCLUSION ( S ) Prior surgery , presence of adhesions , and ovulation drugs are negative prognostic factors . Pregnancy has a protective effect on disease and pain recurrence Two hundred and forty‐two postmenopausal women between 35 and 65 years of age requiring hormone replacement therapy for climacteric symptoms were blindly and r and omly allocated to treatment either with transdermal estradiol therapy ( Estraderm * 50 μg/24 h ) ( E ) or placebo ( P ) . The patches were changed twice a week and treatment continued for 12 weeks . No progestogen supplement therapy was given during the study . No previous hormone replacement therapy had been given for the last six months and the women had had their last menstruation more than sin months ago . As a part of a larger study assessing women 's quality of life , a Swedish version of ‘ McCoy 's Sex Scale Question naire ’ was administered at the start of treatment and after 12 weeks . This question naire contains nine items regarding different aspects of sexual life . The difference between the scorings at the start of treatment and after 12 weeks were calculated for each item and the values Output:

Laparoscopic excision of endometriosis can improve QoSL .

MS2_1shot494

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Purpose : This study evaluated the risk factors for anastomotic leakage after laparoscopic surgery for rectal cancer using a stapling technique . Methods : The total prospect i ve registry of 111 patients with rectal cancer who initially underwent laparoscopic low anterior resection using a stapling technique was review ed . Univariate and multivariate analyses were carried out to identify relevant risk factors . Results : Overall anastomotic leakage rate was 5.4 % ( 6/111 ) . Univariate analysis demonstrated that body mass index ( BMI ) ( P=0.0377 ) was significantly associated with anastomotic leakage . After univariate analysis , the variables of BMI and the size of the circular stapler ( P=0.0923 ) were selected for multivariate analysis , as their P values were < 0.2 , and multivariate analysis demonstrated that BMI was independently predictive of developing anastomotic leakage ( P=0.0458 ) . Conclusions : Laparoscopic surgery for rectal cancer using a stapling technique can be performed safely without increasing the risk of anastomotic leakage , and increased BMI might be a potential risk factor for anastomotic leakage Purpose Laparoscopic surgery of colon cancer has been accepted to be oncologically adequate compared with open resection . However , the situation in rectal cancer remains unclear , because anatomy and complex surgical procedures might specifically influence the long-term outcome . This study was design ed to analyze perioperative and long-term outcome of patients with rectal cancer after laparoscopic vs. open access surgery . Methods A total of 389 patients ( 1998–2005 ) were prospect ively analyzed ; 114 patients had laparoscopic beginning , and 25 patients had conversion and were separately analyzed . Eighty-nine patients remained in the laparoscopic group and 275 had open access surgery . Results Both groups were comparable regarding age , gender , tumor localization , stage , and complications . Differences were found in harvested lymph nodes ( laparoscopic 13.5/open access 16.9 ; P = 0.001 ) and hospitalization ( 15.1/18.7 days ; P = 0.037 ) . Local recurrence rate and metachronous metastasis were comparable . In patients with deep anterior resection with total mesenteric excision , favorable long-term survival in the laparoscopic group was found ( P = 0.035 , log-rank ) . Conclusions Minimally invasive surgery is equivalent in the treatment of rectal cancer and shows advantages of shorter hospitalization and faster recovery . Especially in patients with low rectal cancer , minimally invasive surgery with exact preparation of the total mesenteric excision seems to be favorable compared with open access surgery PURPOSE : This study was design ed to identify the clinical features of anastomotic leakage after laparoscopic resection of rectal cancer and to evaluate the outcomes of laparoscopic management for this problem . METHODS : Prospect ively collected data were obtained from 307 patients with rectal cancer who underwent laparoscopic proctectomy and primary anastomosis . Age , sex , tumor location , tumor stage , body mass index , comorbidities , ileostomy , conversion , intraoperative blood loss , operative time , previous abdominal operation , and hospital stay were analyzed for patients with or without anastomotic leakage . Management and outcome of anastomotic leakage also were analyzed . RESULTS : Anastomotic leakage occurred in 29 patients ( 9.4 percent ) . Diverting ileostomy was initially fashioned in 65 patients ( 21.2 percent ) . Leakage was related to young age , male sex , lower tumor location , and longer operation time . Ten patients ( 34.5 percent ) were successfully managed with conservative treatment . Seventeen patients ( 58.6 percent ) were managed via a laparoscopic approach . Open surgery was performed in two patients who showed diffuse fecal soiling or had previous conversion , respectively . There was no mortality . CONCLUSIONS : When leakage occurs , laparotomy or colostomy is not needed routinely . For surgical intervention , the abdominal cavity should be explored first by laparoscopic visualization because the majority of patients can be successfully managed with laparoscopy and ileostomy BACKGROUND Animal studies have documented significantly better preserved postoperative cell-mediated immune function , as measured by serial delayed-type hypersensitivity ( DTH ) challenges , after laparoscopic-assisted than after open bowel resection . Similarly , in humans , the DTH responses after open cholecystectomy have been shown to be significantly smaller than preoperative responses ; whereas after laparoscopic cholecystectomy , no significant change in DTH response has been noted . The purpose of this study was to assess cell-mediated immune function via serial DTH skin testing in patients undergoing laparoscopic or open colectomy . METHODS A total of 35 subjects underwent either laparoscopic ( n = 18 ) or open colectomy ( n = 17 ) in this prospect i ve but not r and omized study . Only patients who were judged to be immunoresponsive by virtue of having responded successfully to a preoperative DTH challenge were eligible for entry in the study . DTH challenges were carried out at three time points in all patients : preoperatively , immediately following surgery , and on the third postoperative day ( POD 3 ) . Responses were measured 48 h after each challenge and the area of in duration calculated . There were no significant differences between the laparoscopic ( LC ) and open ( OC ) colorectal resection groups in regard to demographics , indications for surgery , or type of resection carried out . The percentage of patients transfused was similar in both groups ( 17 % , LC ; 12 % OC ; p = NS ) . In the LC group , all cases were completed without conversion using minimally invasive methods . There were no perioperative deaths , and the rate of postoperative complications was similar in both groups . The preoperative and postoperative DTH results were analyzed and compared within each surgical group using several methods . RESULTS In regards to the OC group results , the median sum-total DTH responses for the day of surgery challenges ( 0.44 + /- 69 cm2 ) and the POD 3 challenges ( 0.72 + /- 3.37 cm2 ) were significantly smaller than the preoperative results ( 3.61 + /- 3.83 cm2 , p < 0.0005 vs op day and p < 0.0003 vs POD 3 results ) . When the LC group results were similarly analyzed , no significant difference in DTH response was noted between the pre- and the postoperative challenge results . Additionally , when the median percent change from baseline was calculated and considered for the OC group 's DTH results , both postoperative challenge time points demonstrated significantly decreased responses when compared to their preoperative results ( vs day of surgery , p < 0.007 ; vs POD 3 , p < 0.006 ) . Similar analysis of the LC group 's results yielded nonsignificant differences between the pre- and postoperative responses . Lastly , when the LC and the OC groups median percent change from baseline results were directly compared for each of the postoperative challenges , a significant difference was noted for the POD 0 challenge ( LC , -21 % ; OC 88 % ; p < 0.004 ) but not for the POD 3 challenge . CONCLUSIONS The postoperative DTH responses of the open surgery patients were significantly smaller than their preoperative responses . This was not the case for the laparoscopic group ( a combination of fully laparoscopic and laparoscopic-assisted resections ) . When the open and laparoscopic groups results are directly compared , regarding the results of the day of surgery DTH challenges , the LC groups median percent change from baseline was significantly less than that observed in the OC group . These results imply that open colorectal resection is associated with a significant suppression of cell-mediated immune response postoperatively , whereas in this study laparoscopic colorectal resection was not . Further human studies are needed to verify these findings and to determine the clinical significance , if any , of this temporary difference in immune function following colon resection Anastomotic leakage is a major complication of rectal cancer surgery . The aim of this study was to investigate risk factors associated with symptomatic anastomotic leakage after total mesorectal excision ( TME ) Purpose The anastomotic leakage rate after rectal resection has been reported to be approximately 2.5 - 21 percent , but most results were associated with open surgery . The aim of this study was to identify risk factors and their relationship to the experience of the surgeon for anastomotic leakage after laparoscopic rectal resection . Methods Between March 2003 and December 2008 , 156 patients underwent a laparoscopic rectal resection without a diverting ileostomy . The patients ' characteristics , the details of treatment , the intraoperative results , and the postoperative results were recorded prospect ively . Univariate and multivariate analyses were applied to identify risk factors for anastomotic leakage . Results The majority of operations were performed for malignant disease ( n = 150 ; 96.2 % ) , and 96 patients ( 61.5 % ) were males . Conversion to open surgery occurred in 1 case ( 0.6 % ) . The anastomotic leak rate was 10.3 % ( 16/156 ) , and there were no mortalities . In the univariate analysis , tumor location , anastomotic level , intraoperative events , and operation time were associated with increased anastomotic leakage rate . In the multivariate analysis , anastomotic level ( odds ratio [ OR ] , 6.855 ; 95 % confidence interval [ CI ] , 1.271 to 36.964 ) and operation time ( OR , 8.115 ; 95 % CI , 1.982 to 33.222 ) were significantly associated with anastomotic leakage . Conclusion The important risk factors for anastomotic leakage after laparoscopic rectal resection without a diverting ileostomy were low anastomosis and long operation time . An additional procedure , such as diverting stoma , may reduce the anastomotic leakage if it is selectively applied in cases with these risk factors BACKGROUND Laparoscopic rectal transection carries the risk of anastomotic leakage because of its technical difficulty and long staple line with an inadequate cutting angle . Our objective was to investigate the risk factors affecting anastomotic leakage after laparoscopic intracorporeal colorectal anastomosis with a double stapling technique . STUDY DESIGN Between November 2006 and September 2008 , 270 consecutive patients underwent laparoscopic sigmoidectomy and anterior resection with double stapling technique for distal sigmoid and rectal cancer . Data were collected prospect ively . Univariate and multivariate analyses were performed to determine risk factors for anastomotic leakage . Additionally , we evaluated the relationship between the number of stapler firings and clinical parameters . RESULTS Anastomotic leakage was noted in 17 ( 6.3 % ) of 270 patients . In univariate analyses , tumor location ( p = 0.021 ) , operation time ( p = 0.025 ) , number of stapler firings ( p = 0.040 ) , and diameter of the circular stapler ( p = 0.022 ) were significant risk factors for anastomotic leakage . Multivariate analyses showed that middle or lower rectal cancer was an independent factor affecting anastomotic leakage ( p = 0.013 ) . The number of stapler firings increased significantly in men ( p = 0.023 ) , in patients with a tumor at a lower level ( p = 0.034 ) , and in those with longer operation times ( p < 0.001 ) . CONCLUSIONS A reduction in the number of linear stapler firings is necessary to avoid anastomotic leakage after laparoscopic colorectal anastomosis with a double stapling technique . We recommend that a diverting ileostomy is m and atory in patients with middle and lower rectal cancer where multiple linear staplers were used Background This study aim ed to prospect ively evaluate operative safety and mid-term oncologic outcomes of laparoscopic rectal cancer resection performed by a single surgeon . Methods Three hundreds twelve patients ( male , 181 ) were enrolled in this analysis . 257 patients ( 82.4 % ) had tumors located below 12 cm from the anal verge . Distribution of TNM stages was 0:I : II : III : IV = 4.2%:17.9%:32.4%:37.2%:8.3 % . 225 patients ( 71.1 % ) had T3/T4 lesions . Pre- and post-operative radiation was given in 6 and 20 patients , respectively . Results Sphincter-preserving operation was performed in 85.9 % . Mean operating time was 212 minutes . Conversion rate was 2.6 % . Overall morbidity rate was 21.1 % . Anastomotic leakage occurred in 6.4 % . Operative mortality rate was 0.3 % . Mean number of harvested nodes was 23 . Mean distal tumor-free margin was 2.8 cm . The circumferential resection margin was positive in 13 patients ( 4.2 % ) . With a mean follow-up of 30 months in the stage I – III patients , the local recurrence rate was 2.9 % . Systemic recurrence occurred in 11.7 % . No port-site recurrence was observed . Conclusion Laparoscopic resection of rectal cancer provided safe operative parameters and adequate mid-term oncologic outcomes . When considering a high volume of advanced and Output:

Conclusion Our analysis identified several clinicopathologic factors associated with AL in patients who underwent LAR . The knowledge of these risk factors may influence treatment- and procedure-related decisions and possibly reduce the leakage rate

MS2_1shot495

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: We compared neonatal outcomes in twin pregnancies following moderately preterm birth ( MPTB ) , late preterm birth ( LPTB ) , and term birth . A secondary analysis of a multicenter , r and omized controlled trial of multiple gestations was conducted . MPTB was defined as delivery between 32 (0)/(7 ) and 33 (6)/(7 ) weeks and LPTB between 34 (0)/(7 ) and 36 (6)/(7 ) weeks . Primary outcome was a neonatal outcome composite consisting of one or more of the following : neonatal death , respiratory distress syndrome , early onset culture-proven sepsis , stage 2 or 3 necrotizing enterocolitis , bronchopulmonary dysplasia , grade 3 or 4 intraventricular hemorrhage , periventricular leukomalacia , pneumonia , or severe retinopathy of prematurity . Among 552 twin pregnancies , the MPTB rate was 14.5 % , LPTB 49.8 % , and term birth rate 35.7 % . The rate of the primary outcome was different between groups : 30.0 % for MPTB , 12.8 % for LPTB , 0.5 % for term birth ( P < 0.001 ) . Compared with term neonates , the primary neonatal outcome composite was increased following MPTB ( relative risk [ RR ] 58.5 ; 95 % confidence interval [ CI ] 11.3 to 1693.0 ) and LPTB ( RR 24.9 ; 95 % CI 4.8 to 732.2 ) . Twin pregnancies born moderately and late preterm encounter higher rates of neonatal morbidities compared with twins born at term OBJECTIVES To determine whether progesterone supplementation alters cervical shortening in women at increased risk for preterm birth . METHODS We performed a planned secondary analysis from a large , multinational preterm birth prevention trial of daily intravaginal progesterone gel , 90 mg , compared with placebo in women with a history of spontaneous preterm birth or premature cervical shortening . Transvaginal cervical length measurements were obtained in all r and omized patients at baseline ( 18 + 0 to 22 + 6 weeks ' gestation ) and at 28 weeks ' gestation . For this secondary analysis , the difference in cervical length between these time points was compared for the study population with a history of spontaneous preterm birth and for a population with premature cervical shortening ( < or = 30 mm ) at r and omization . Differences between groups in cervical length for the 28-week examination were analyzed using ANCOVA , including adjustment for relevant clinical parameters and maternal characteristics . RESULTS Data were analyzed from 547 r and omized patients with a history of preterm birth . The progesterone-treated patients had significantly less cervical shortening than the placebo group ( difference 1.6 ( 95 % CI , 0.3 - 3.0 ) mm ; P = 0.02 , ANCOVA ) . In the population of 104 subjects with premature cervical shortening at r and omization , the cervical length also differed significantly on multivariable analysis , with the treatment group preserving more cervical length than the placebo group ( difference 3.3 ( 95 % CI , 0.3 - 6.2 ) mm ; P = 0.03 , ANCOVA ) , with adjustment for differences in cervical length at screening . A significant difference was also observed between groups for categorical outcomes including the frequency of cervical length progression to < or = 25 mm and a > or = 50 % reduction in cervical length from baseline in this sub population . CONCLUSIONS Intravaginal progesterone enhances preservation of cervical length in women at high risk for preterm birth BACKGROUND Midtrimester amniocentesis to investigate fetal karyotype carries a small risk of fetal loss . AIM To test the hypothesis that progesterone prophylaxis may reduce this . STUDY DESIGN A r and omised controlled trial comparing a short prophylactic treatment with progesterone after amniocentesis with untreated controls . RESULTS There were no differences in frequency of miscarriage , preterm delivery or neonatal outcome . CONCLUSION Prophylactic progesterone treatment after amniocentesis does not improve obstetric outcome OBJECTIVE : A multicenter , r and omized placebo-controlled trial among women with singleton pregnancies and a history of spontaneous preterm birth found that weekly injections of 17 alpha-hydroxyprogesterone caproate ( 17P ) , initiated between 16 and 20 weeks of gestation , reduced preterm birth by 33 % . The current study estimated both preterm birth recurrence and the potential reduction in the national preterm birth rate . METHODS : Using 2002 national birth certificate data , augmented by vital statistics from 2 states , we estimated the number of singleton births delivered to women eligible for 17P through both a history of spontaneous preterm birth and prenatal care onset within the first 4 months of pregnancy . The number and rate of recurrent spontaneous preterm births were estimated . To predict effect , the reported 33 % reduction in spontaneous preterm birth attributed to 17P therapy was applied to these estimates . RESULTS : In 2002 , approximately 30,000 recurrent preterm births occurred to women eligible for 17P , having had a recurrent preterm birth rate of 22.5 % . If 17P therapy were delivered to these women , nearly 10,000 spontaneous preterm births would have been prevented , thereby reducing the overall United States preterm birth rate by approximately 2 % , from 12.1 % to 11.8 % ( P < .001 ) , with higher reductions in targeted groups of eligible pregnant women . CONCLUSION : Use of 17P could reduce preterm birth among eligible women , but would likely have a modest effect on the national preterm birth rate . Additional research is urgently needed to identify other population s who might benefit from 17P , evaluate new methods for early detection of women at risk , and develop additional prevention strategies . LEVEL OF EVIDENCE : Background 15 % of multiple pregnancies ends in a preterm delivery , which can lead to mortality and severe long term neonatal morbidity . At present , no generally accepted strategy for the prevention of preterm birth in multiple pregnancies exists . Prophylactic administration of 17-alpha hydroxyprogesterone caproate ( 17OHPC ) has proven to be effective in the prevention of preterm birth in women with singleton pregnancies with a previous preterm delivery . At present , there are no data on the effectiveness of progesterone in the prevention of preterm birth in multiple pregnancies . Methods / Design We aim to investigate the hypothesis that 17OHPC will reduce the incidence of the composite neonatal morbidity of neonates by reducing the early preterm birth rate in multiple pregnancies . Women with a multiple pregnancy at a gestational age between 15 and 20 weeks of gestation will be entered in a placebo-controlled , double blinded r and omised study comparing weekly 250 mg 17OHPC intramuscular injections from 16–20 weeks up to 36 weeks of gestation versus placebo . At study entry , cervical length will be measured . The primary outcome is composite bad neonatal condition ( perinatal death or severe morbidity ) . Secondary outcome measures are time to delivery , preterm birth rate before 32 and 37 weeks , days of admission in neonatal intensive care unit , maternal morbidity , maternal admission days for preterm labour and costs . We need to include 660 women to indicate a reduction in bad neonatal outcome from 15 % to 8 % . Analysis will be by intention to treat . We will also analyse whether the treatment effect is dependent on cervical length . Discussion This trial will provide evidence as to whether or not 17OHPC-treatment is an effective means of preventing bad neonatal outcome due to preterm birth in multiple pregnancies . Trial registration Current Controlled Trials IS RCT Objective . To compare rates of preterm birth before 35 weeks based on cervical length measurement at 16–20 weeks in women with twin gestations who received 17-α hydroxyprogesterone caproate ( 17OHPC ) or placebo . Methods . This is a secondary analysis of a r and omised , double-blind , placebo-controlled trial of twin gestations exposed to 17OHPC or placebo . Baseline transvaginal ultrasound evaluation of cervical length was performed prior to treatment assignment at 16–20 weeks . Cervical length measurements were categorised according to the 10th , 25th , 50th and 75th percentiles in the women studied . The effect of 17OHPC administration in women with a short ( 25th percentile ) and long ( 75th percentile ) cervix was evaluated . Results . Of 661 twin gestations studied , 221 ( 33.4 % ) women enrolled at 11 centers underwent cervical length measurement . The 10th , 25th , 50th , 75th percentiles for cervical length at 16–20 weeks were 32 , 36 , 40 and 44 mm , respectively . The risk of preterm birth < 35 weeks was increased in women with a cervical length < 25th percentile ( 55.8 vs. 36.9 % , p = 0.02 ) . However , a cervical length > 75th percentile at this gestational age interval was not protective for preterm birth ( 36.5 vs. 42.9 % , p = 0.42 ) . Administration of 17OHPC did not reduce preterm birth before 35 weeks among those with either a short or a long cervix ( 64.3 vs. 45.8 % , p = 0.18 and 38.1 vs. 35.5 % , p = 0.85 , respectively ) . Conclusion . Women with twin gestations and a cervical length below the 25th percentile at 16–20 weeks had higher rates of preterm birth . In this subgroup of women , 17 OHPC did not prevent preterm birth before 35 weeks gestation . A cervical length above the 75th percentile at 16–20 weeks did not significantly reduce the risk of preterm birth in this high risk population Whilst only about a third of all cerebral palsy occurs in children who had been of low birthweight , recent increases in the survival of low and very low birthweight infants have coincided with significant increases in the numbers of cerebral palsy children amongst them . This paper analyses data from the Western Australian Cerebral Palsy Register and from the Maternal and Child Health Research Data Base for stillbirths , neonatal deaths and survivors to address the issues of increased survival , cerebral palsy and timing of brain damage . The analysis is inconclusive but suggestive that both antenatal and postnatal complications are important in the increases in cerebral palsy in low birthweight infants . The good news is that this means that a certain proportion of postnatally damaged low birthweight survivors could possibly be prevented by better neonatal care . The bad news is that the remaining proportion have probably received their damage well before delivery and the possibilities for prevention are still remote . Further studies of low birthweight infants with cerebral palsy are urgently required . They should include antenatal factors , investigating the various aetiological pathways to preterm birth , r and omised controlled trials of neonatal interventions and search ing for better neonatal predictors of brain damage The aim of this study was to evaluate the effect of vaginal natural progesterone on the prevention of preterm birth in IVF/intracytoplasmic sperm injection ( ICSI ) pregnancies . A single-centre prospect i ve placebo-controlled r and omized study was performed . A total of 313 IVF/ICSI pregnant patients were r and omized into two groups for either treatment with daily 400 mg vaginal natural progesterone or placebo , starting from mid-trimester up to 37 weeks or delivery . Amongst the patients , there were 215 singleton and 91 twin pregnancies . There was no significant difference in risk of preterm birth among all patients ( OR 0.672 , 95 % CI 0.42 - 1.0 . There was a significantly lower preterm birth rate in singleton pregnancies in the natural progesterone arm ( OR 0.53 , 95 % CI 0.28 - 0.97 ) and no significant difference between both arms in twin pregnancies ( OR 0.735 , 95 % CI 0.36 - 2 ) . In conclusion , the administration of 400 mg vaginal natural progesterone from mid trimester reduced the incidence of preterm birth in singleton , but not in twin , IVF/ICSI pregnancies Background Women with a short cervical length in mid-trimester pregnancy have a higher risk of preterm birth and therefore a higher rate of neonatal mortality and morbidity . Progesterone can potentially decrease the number of preterm births and lower neonatal mortality and morbidity . Previous studies showed good results of progesterone in women with either a history of preterm birth or a short cervix . However , it is unknown whether screening for a short cervix and subsequent treatment in mid trimester pregnancy is effective in low risk women . Methods / Design We plan a combined screen and treat study among women with a singleton pregnancy without a previous preterm birth . In these women , we will measure cervical length at the st and ard anomaly scan performed between 18 and 22 weeks . Women with cervical length ≤ 30 mm at two independent measurements will be r and omly allocated to receive either vaginal progesterone Output:

No differential effects in terms of route of administration , time of commencing therapy and dose of progesterone were observed for the majority of outcomes examined . The use of progesterone is associated with benefits in infant health following administration in women considered to be at increased risk of preterm birth due either to a prior preterm birth or where a short cervix has been identified on ultrasound examination .

MS2_1shot496

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Objective To determine the frequency and predictors of compliance with h and hygiene ( HH ) practice in pediatric intensive care . Design Observational , prospect i ve cohort study performed from February to April 2000 . Setting Three intensive care units at a tertiary care children ’s hospital . Participants Nurses , physicians , respiratory therapists , and other healthcare workers . Methods During 156 30-min daytime observation periods , an unidentified observer monitored 2811 opportunities for HH during patient care and recorded HH compliance . Measurements and Main Results Average HH compliance was 34 % ( 946/2811 ) . It was higher ( p < 0.001 ) among respiratory therapists ( 68 % ; 171/251 ) than physicians ( 37 % ; 157/426 ) or nurses ( 29 % ; 587/2031 ) . Contact with body fluid secretions was associated with the highest compliance ( 77 % ; 46/60 ) , and contact with wounds ( 71 % ; 10/14 ) or indwelling devices ( 66 % ; 110/167 ) were associated with somewhat lesser compliance . The following were important predictors of compliance ( all p < 0.01 ) : being a respiratory therapist ( odds ratio [ OR ] , 5.1 ) ; working in the neonatal intensive care unit ( OR , 1.6 ) ; and contact with invasive devices ( OR , 2.5 ) , wounds ( OR , 6.9 ) , or body fluids ( OR , 11.5 ) . Compliance was lowest after interrupted patient-care activities ( 9 % ; OR , 0.15 ) . Surprisingly , decreased patient-to-nurse ratio ( mean , 1.3 ± 0.3 ) or opportunities per hr of care ( mean , 37 ± 7 ) were not independent predictors of compliance . Conclusions Average HH compliance was low , but it increased during high-risk patient-care activities . Intensified efforts are necessary to increase caretakers ’ compliance and the awareness of the risk of bacterial contamination after interrupted patient-care activities Context : The role of h and hygiene in preventing health care associated infections ( HCAIs ) has been clearly established . However , compliance rates remain poor among health care personnel . Aims : a ) To investigate the health care workers ’ h and hygiene compliance rates in the intensive care unit ( ICU ) , b ) to assess reasons for non-compliance and c ) to study the efficacy of a multimodal intervention strategy at improving compliance . Setting s : A mixed medical – surgical ICU of a tertiary level hospital . Design : A before – after prospect i ve , observational , intervention study . Material s and Methods : All health care personnel who came in contact with patients in the ICU were observed for their h and hygiene compliance before and after a multimodal intervention strategy ( education , posters , verbal reminders and easy availability of products ) . A self-report question naire was also circulated to assess perceptions regarding compliance . Statistical analysis was done using χ2 test or Fisher exact test ( Epi info software ) . Results : H and hygiene compliance among medical personnel working in the ICU was 26 % and the most common reason cited for non-compliance was lack of time ( 37 % ) . The overall compliance improved significantly following the intervention to 57.36 % ( P<0.000 ) . All health care worker groups showed significant improvements : staff nurses ( 21.48–61.59 % , P<0.0000 ) , nursing students ( 9.86–33.33 % , P<0.0000 ) , resident trainees ( 21.62–60.71 % , P<0.0000 ) , visiting consultants ( 22–57.14 % , P=0.0001 ) , physiotherapists ( 70–75.95 % , P=0.413 ) and paramedical staff ( 10.71–55.45 % , P < 0.0000 ) . Conclusions : H and hygiene compliance among health care workers in the ICU is poor ; however , intervention strategies , such as the one used , can be useful in improving the compliance rates significantly Background Frequent h and washing can prevent infections , but non-compliance to h and hygiene is pervasive . Few theory- and evidence -based interventions to improve regular h and washing are available . Therefore , two intervention modules , a motivational and a self-regulatory one , were design ed and evaluated . Methods In a longitudinal study , 205 young adults , aged 18 to 26 years , were r and omized into two intervention groups . The Mot-SelfR group received first a motivational intervention ( Mot ; risk perception and outcome expectancies ) followed by a self-regulatory intervention ( SelfR ; perceived self-efficacy and planning ) 17 days later . The SelfR-Mot group received the same two intervention modules in the opposite order . Follow-up data were assessed 17 and 34 days after the baseline . Results Both intervention sequences led to an increase in h and washing frequency , intention , self-efficacy , and planning . Also , overall gains were found for the self-regulatory module ( increased planning and self-efficacy levels ) and the motivational module ( intention ) . Within groups , the self-regulatory module appeared to be more effective than the motivational module , independent of sequence . Conclusions Self-regulatory interventions can help individuals to exhibit more h and washing . Sequencing may be important as a motivation module ( Mot ) first helps to set the goal and a self-regulatory module ( SelfR ) then helps to translate this goal into actual behavior , but further research is needed to evaluate mechanisms BACKGROUND H and hygiene compliance among health care providers is considered to be the single most effective factor to reduce hospital acquired infections . Despite continuous education and awareness , compliance with h and hygiene guidelines has remained low , particularly during evening shifts . OBJECTIVE Our objective was to determine the compliance with h and hygiene guidelines among doctors , nurses , and paramedical staff during day and night duties in a multidisciplinary intensive care unit ( ICU ) . METHODS We used a prospect i ve , observational , 6-month study conducted in a 34-bed ICU within a tertiary care teaching hospital . All doctors , nurses , and paramedical staff in the ICU were included . An investigator , placed within the ICU setting , observed the h and hygiene practice s during day and night . Day and night shift change times were 08:00 and 20:00 hours , respectively . RESULTS Of the 5639 opportunities for h and hygiene , 3383 ( 59.9 % ) were properly performed . Overall rates of compliance were 66.1 % for doctors , 60.7 % for nurses , and 38.6 % for paramedical staff . H and hygiene compliance dropped during the night for doctors ( 81 % vs 46 % , respectively , P < .001 ) , for nurses ( 64 % vs 55 % , respectively , P = .02 ) , and for paramedical staff ( 44 % vs 31 % , respectively , P = .01 ) . Characterization of noncompliance is as follows : " No h and washing after procedure " in 41 % , " improper duration of h and washing " in 32 % , and " no h and washing done at all " in 27 % of the events . " No h and washing done at all " occurred in 55 % of the time at night with doctors having the highest rate of noncompliance , making 163 ( 34 % ) contacts without h and washing . CONCLUSION Whereas compliance with h and hygiene guidelines was lower at night compared with day , irrespective of discipline in all 3 groups of health care providers , both periods of compliance would benefit from additional training focusing on the importance of h and hygiene around the clock BACKGROUND Although h and hygiene ( HH ) compliance has been an important issue for years , the compliance rate is still a problem in health care today . METHODS This was an observational , prospect i ve , before- and -after study . We measured HH knowledge and HH compliance before ( baseline ) , directly after ( post strategy ) , and 6 months after the performance of HH team strategies ( follow-up ) . The study was composed of employed nurses and physicians working in the department of internal medicine of a university hospital . We performed a multifaceted improvement program including HH education , feedback , reminders , social influence activities including the use of role models , and improvement of HH facilities . RESULTS Ninety-two nurses and physicians were included . Compared with baseline , there was a significant improvement in the overall mean HH knowledge score at post strategy ( from 7.4 to 8.4 ) and follow-up ( from 7.4 to 8.3 ) . The overall HH compliance was 27 % at baseline , 83 % at post strategy , and 75 % at follow-up . At baseline , the compliance rate was 17 % in nurses and 43 % in physicians and significantly improved to 63 % in nurses and 91 % in physicians at follow-up . CONCLUSION Our multifaceted HH improvement program result ed in a sustained improvement of HH knowledge and compliance in nurses as well as physicians OBJECTIVES . H and hygiene promotion interventions rarely result in sustained improvement , and an assessment of their impact on individual infection risk has been lacking . We sought to measure the impact of h and hygiene promotion on health care worker compliance and health care – associated infection risk among neonates . METHODS . We conducted an intervention study with a 9-month follow-up among all of the health care workers at the neonatal unit of the Children 's Hospital , University of Geneva Hospitals , between March 2001 and February 2004 . A multifaceted h and hygiene education program was introduced with compliance assessed during successive observational surveys . Health care – associated infections were prospect ively monitored , and genotypic relatedness of bloodstream pathogens was assessed by pulsed-field gel electrophoresis . A comparison of observed h and hygiene compliance and infection rates before , during , and after the intervention was conducted . RESULTS . A total of 5325 opportunities for h and hygiene were observed . Overall compliance improved gradually from 42 % to 55 % across study phases . This trend remained significant after adjustment for possible confounders and paralleled the measured increase in h and -rub consumption ( from 66.6 to 89.2 L per 1000 patient-days ) . A 9-month follow-up survey showed sustained improvement in compliance ( 54 % ) , notably with direct patient contact ( 49 % at baseline vs 64 % at follow-up ) . Improved compliance was independently associated with infection risk reduction among very low birth weight neonates . Bacteremia caused by clonally related pathogens markedly decreased after the intervention . CONCLUSIONS . H and hygiene promotion , guided by health care workers ' perceptions , identification of the dynamics of bacterial contamination of health care workers ' h and s , and performance feedback , is effective in sustaining compliance improvement and is independently associated with infection risk reduction among high-risk neonates OBJECTIVES To assess h and washing frequency according to CDC recommendations ; and to test a simple intervention to increase h and washing compliance , design ed for the unique setting of the ED . METHODS A prospect i ve , observational , before- and -after study design with a convenience sampling technique was used to assess h and washing compliance in the ED of a 742-bed urban , university-affiliated medical center with 65,000 visits annually . Emergency physicians ( EPs ) , registered nurses ( RNs ) , and nurse practitioners ( NPs ) were informed that their patient encounters were being monitored , but the nature of the study was kept confidential . A single observer evaluated individual EPs , RNs , and NPs in one- , two- , or three-hour blocks , recording compliance with CDC h and washing recommendations . After two weeks , brightly colored signs with CDC recommendations for h and washing were posted at all sinks and a copy of a related publication on h and washing by medical personnel was distributed to all staff . H and washing behaviors were again observed . RESULTS A total of 252 situations requiring h and washing were observed , 132 pre-intervention and 120 post-intervention . Total h and washing , h and washing by each staff design ation , and h and washing in each CDC recommendation category -- except h and washing between contacts with different patients --all showed tendencies toward improvement , though none was significant ( p > 0.05 ) . Both the NPs and RNs demonstrated significantly higher adherence to recommended h and washing between patients after the intervention than did the EPs ( 85 % vs 71 % vs 31 % , p < 0.01 and p < 0.05 , respectively ) . CONCLUSION Despite a trend in improvement of compliance with CDC recommendations , h and washing among ED personnel remained unacceptably low BACKGROUND Improving h and hygiene compliance is still a major challenge for most hospitals . Innovative approaches are needed . OBJECTIVE We tested whether an innovative , theory based , team and leaders-directed strategy would be more effective in increasing h and hygiene compliance rates in nurses than a literature based state-of-the-art strategy . DESIGN AND SETTING A cluster r and omised controlled trial called HELPING H AND S was conducted in 67 nursing wards of three hospitals in the Netherl and s. PARTICIPANTS All affiliated nurses of the nursing wards . Wards were r and omly assigned to either the team and Output:

Conclusions : Published research of h and hygiene compliance measured by direct observation lacks validity .

MS2_1shot497

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Stress plays an important role in the development of symptoms contributing to disease . Stress induces various disorders with gastrointestinal , physical , and psychological symptoms . Probiotics can help regulate or modulate gastrointestinal functions . The aim of the present study was to investigate the effects of a probiotic preparation ( Probio-Stick ) on stress-induced symptoms in volunteers . A double-blind , placebo-controlled , r and omized study was conducted on volunteers with symptoms of stress . Subjects received a probiotic ( Probio-Stick ; Lallem and SAS , Saint-Simon , France ) containing Lactobacillus acidophilus Rosell-52 and Bifidobacterium longum Rosell-175 ( 3 x 10(9 ) colony-forming units per sachet stick ) or a sensorially identical placebo without probiotics during a 3-week period . The consumption of probiotics significantly reduced 2 stress-induced gastrointestinal symptoms ( abdominal pain and nausea/vomiting ) for intention-to-treat or per- protocol population s. In contrast , the probiotics did not significantly modify the other physical and psychological symptoms and sleep problems induced by stressful life events for intention-to-treat or per- protocol population s. The results indicate that Probio-Stick can provide a beneficial effect on the gastrointestinal symptoms experienced by individuals affected by chronic stress Objective : The impact on mood and memory of consuming a probiotic containing milk drink , or a placebo , was examined as , previously , a poor mood has been found to correlate with the frequency of constipation . Design : A double-blind placebo-controlled trial with r and om allocation of subjects . Setting : Subjects went about their normal life in the community apart from three visits to the laboratory . Subjects : One hundred and thirty-two healthy members of general population , mean age 61.8 years , volunteered in response to local media coverage . One hundred and twenty-four finished the trial . Intervention : For a 3-week period , either a probiotic containing milk drink , or a placebo , were consumed daily . Mood and cognition were measured at baseline , and after 10 and 20 days of consumption . Results : At baseline those who reported themselves to be less frequently constipated were more clearheaded , confident and elated . Although the taking of the probiotic did not generally change the mood , this appeared to be a reflection of the generally good mood in this sample . When those in the bottom third of the depressed/elated dimension at baseline were considered , they selectively responded by reporting themselves as happy rather than depressed after taking the probiotic . The intervention did not , however , influence the reported frequency of defaecation , probably a reflection of the initially low incidence of constipation . An unexpected and possibly chance finding was that the consumption of probiotics result ed in a slightly-poorer performance on two measures of memory . Conclusions : The consumption of a probiotic-containing yoghurt improved the mood of those whose mood was initially poor . This improvement in mood was not , however , associated with an increased frequency of defaecation . Sponsorship : Funded by Yakult , Japan Oral intake of Lactobacillus pentosus strain b240 ( b240 ) has been shown to enhance the secretion of salivary secretory IgA in elderly adults . However , its clinical benefits remain to be determined . We tested the hypothesis that b240 exerts a protective effect against the common cold in elderly adults . The design of the present study was a r and omised , double-blind , placebo-controlled trial ( RCT ) with parallel three-group comparison . For this purpose , 300 eligible elderly adults were r and omly allocated to one of three groups , namely a placebo , low-dose or high-dose b240 group . Participants in the low-dose and high-dose b240 groups were given tablets containing 2 × 10(9 ) or 2 × 10(10 ) cells , respectively , of heat-killed b240 , while those in the placebo group were given tablets without b240 . Each group consumed their respective tablets once daily for 20 weeks . The common cold was assessed on the basis of a diary . Change in quality of life was evaluated using the SF-36 . Of the total participants , 280 completed the 20-week RCT . The accumulated incidence rate of the common cold was 47·3 , 34·8 and 29·0 % for the placebo , low-dose b240 and high-dose b240 groups , respectively ( P for trend = 0·012 ) . Lower incidence rates were consistently observed throughout the experimental period in the b240 groups ( log-rank test , P= 0·034 ) . General health perception , as determined by the SF-36 ® , dose-dependently increased in the b240 groups ( P < 0·025 ) . In conclusion , oral intake of b240 significantly reduced the incidence rate of the common cold in elderly adults , indicating that b240 might be useful in improving resistance against infection through mucosal immunity BACKGROUND : Probiotic bacteria exhibit a variety of properties , including immunomodulatory activity , which are unique to a particular strain . Thus , not all species will necessarily have the same therapeutic potential in a particular condition . We have preliminary evidence that Bifidobacterium infantis 35624 may have utility in irritable bowel syndrome ( IBS ) . OBJECTIVES : This study was design ed to confirm the efficacy of the probiotic bacteria B. infantis 35624 in a large-scale , multicenter , clinical trial of women with IBS . A second objective of the study was to determine the optimal dosage of probiotic for administration in an encapsulated formulation . METHODS : After a 2-wk baseline , 362 primary care IBS patients , with any bowel habit subtype , were r and omized to either placebo or freeze-dried , encapsulated B. infantis at a dose of 1 × 106 , 1 × 108 , or 1 × 1010 , cfu/mL for 4 wk . IBS symptoms were monitored daily and scored on to a 6-point Likert scale with the primary outcome variable being abdominal pain or discomfort . A composite symptom score , the subject 's global assessment of IBS symptom relief , and measures of quality of life ( using the IBS-QOL instrument ) were also recorded . RESULTS : B. infantis 35624 at a dose of 1 × 108 cfu was significantly superior to placebo and all other bifidobacterium doses for the primary efficacy variable of abdominal pain as well as the composite score and scores for bloating , bowel dysfunction , incomplete evacuation , straining , and the passage of gas at the end of the 4-wk study . The improvement in global symptom assessment exceeded placebo by more than 20 % ( p < 0.02 ) . Two other doses of probiotic ( 1 × 106 and 1 × 1010 ) were not significantly different from placebo ; of these , the 1 × 1010 dose was associated with significant formulation problems . No significant adverse events were recorded . CONCLUSIONS : B. infantis 35624 is a probiotic that specifically relieves many of the symptoms of IBS . At a dosage level of 1 × 108 cfu , it can be delivered by a capsule making it stable , convenient to administer , and amenable to widespread use . The lack of benefits observed with the other dosage levels of the probiotic highlight the need for clinical data in the final dosage form and dose of probiotic before these products should be used in practice BACKGROUND & AIMS Probiotics can reduce symptoms of irritable bowel syndrome ( IBS ) , but little is known about their effects on psychiatric comorbidities . We performed a prospect i ve study to evaluate the effects of Bifidobacterium longum NCC3001 ( BL ) on anxiety and depression in patients with IBS . METHODS We performed a r and omized , double-blind , placebo-controlled study of 44 adults with IBS and diarrhea or a mixed-stool pattern ( based on Rome III criteria ) and mild to moderate anxiety and /or depression ( based on the Hospital Anxiety and Depression scale ) at McMaster University in Canada , from March 2011 to May 2014 . At the screening visit , clinical history and symptoms were assessed and blood sample s were collected . Patients were then r and omly assigned to groups and given daily BL ( n = 22 ) or placebo ( n = 22 ) for 6 weeks . At weeks 0 , 6 , and 10 , we determined patients ' levels of anxiety and depression , IBS symptoms , quality of life , and somatization using vali date d question naires . At weeks 0 and 6 , stool , urine and blood sample s were collected , and functional magnetic resonance imaging ( fMRI ) test was performed . We assessed brain activation patterns , fecal microbiota , urine metabolome profiles , serum markers of inflammation , neurotransmitters , and neurotrophin levels . RESULTS At week 6 , 14 of 22 patients in the BL group had reduction in depression scores of 2 points or more on the Hospital Anxiety and Depression scale , vs 7 of 22 patients in the placebo group ( P = .04 ) . BL had no significant effect on anxiety or IBS symptoms . Patients in the BL group had a mean increase in quality of life score compared with the placebo group . The fMRI analysis showed that BL reduced responses to negative emotional stimuli in multiple brain areas , including amygdala and fronto-limbic regions , compared with placebo . The groups had similar fecal microbiota profiles , serum markers of inflammation , and levels of neurotrophins and neurotransmitters , but the BL group had reduced urine levels of methylamines and aromatic amino acids metabolites . At week 10 , depression scores were reduced in patients given BL vs placebo . CONCLUSION In a placebo-controlled trial , we found that the probiotic BL reduces depression but not anxiety scores and increases quality of life in patients with IBS . These improvements were associated with changes in brain activation patterns that indicate that this probiotic reduces limbic reactivity . Clinical Trials.gov no. NCT01276626 Objectives : This trial investigated whether probiotics improved mood , stress and anxiety in a sample selected for low mood . We also tested whether the presence or severity of irritable bowel syndrome symptoms , and levels of proinflammatory cytokines , brain-derived neurotrophic factor and other blood markers , would predict or impact treatment response . Method : Seventy-nine participants ( 10 dropouts ) not currently taking psychotropic medications with at least moderate scores on self-report mood measures were r and omly allocated to receive either a probiotic preparation ( containing Lactobacillus helveticus and Bifidobacterium longum ) or a matched placebo , in a double-blind trial for 8 weeks . Data were analysed as intent-to-treat . Results : No significant difference was found between the probiotic and placebo groups on any psychological outcome measure ( Cohen ’s d range = 0.07–0.16 ) or any blood-based biomarker . At end-point , 9 ( 23 % ) of those in the probiotic group showed a ⩾60 % change on the Montgomery – Åsberg Depression Rating Scale ( responders ) , compared to 10 ( 26 % ) of those in the placebo group ( χ 1 2 = 0 . 107 , p = ns ) . Baseline vitamin D level was found to moderate treatment effect on several outcome measures . Dry mouth and sleep disruption were reported more frequently in the placebo group . Conclusions : This study found no evidence that the probiotic formulation is effective in treating low mood , or in moderating the levels of inflammatory and other biomarkers . The lack of observed effect on mood symptoms may be due to the severity , chronicity or treatment resistance of the sample ; recruiting an antidepressant-naive sample experiencing mild , acute symptoms of low mood , may well yield a different result . Future studies taking a preventative approach or using probiotics as an adjuvant treatment may also be more effective . Vitamin D levels should be monitored in future studies in the area . The results of this trial are preliminary ; future studies in the area should not be discouraged BACKGROUND & AIMS Changes in gut microbiota have been reported to alter signaling mechanisms , emotional behavior , and visceral nociceptive reflexes in rodents . However , alteration of the intestinal microbiota with antibiotics or probiotics has not been shown to produce these changes in humans . We investigated whether consumption of a fermented milk product with probiotic ( FMPP ) for 4 weeks by healthy women altered brain intrinsic connectivity or responses to emotional attention tasks . METHODS Healthy women with no gastrointestinal or psychiatric symptoms were r and omly assigned to groups given FMPP ( n = 12 ) , a nonfermented milk product ( n = 11 , controls ) , or no intervention ( n = 13 ) twice daily for 4 weeks . The FMPP contained Bifidobacterium animalis subsp Lactis , Streptococcus thermophiles , Lactobacillus bulgaricus , and Lactococcus lactis subsp Lactis . Participants underwent functional magnetic resonance imaging before and after the intervention to measure brain response to an emotional faces attention task and resting brain activity . Multivariate and region of interest analyses were performed . RESULTS FMPP intake was associated with reduced task-related response of a distributed functional network ( 49 % cross-block covariance ; P = .004 ) containing affective , viscerosensory , and somatosensory cortices . Alterations Output:

Nonetheless , probiotics seem to potentially produce a significant therapeutic effect for subjects with pre-existing depressive symptoms .

MS2_1shot498

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Background : The effects on morbidity were examined of providing an educational intervention and a written guided self-management plan to the parents of pre-school children following a recent attendance at hospital for asthma or wheeze . Methods : A prospect i ve , r and omised , partially blinded , controlled trial was design ed at two secondary care centres . Over a 13 month period 200 children aged 18 months to 5 years at the time of admission to a children 's ward or attendance at an accident and emergency department or children 's ( emergency ) assessment unit ( A&E/CAU ) with a primary diagnosis of acute severe asthma or wheezing were recruited . 101 children were r and omised into the control group and received usual care and 99 were assigned to the intervention group and received : ( 1 ) a pre-school asthma booklet ; ( 2 ) a written guided self-management plan ; and ( 3 ) two 20 minute structured educational sessions between a specialist respiratory nurse and the parent(s ) and child . Subjects were assessed at 3 , 6 , and 12 months . The main outcomes were GP consultation rates , hospital re-admissions , and attendances at A&E/CAU . Secondary outcomes included disability score , caregivers ' quality of life , and parental knowledge of asthma . Results : There were no statistically significant differences between the two groups during the 12 month follow up period for any of the main or secondary outcome measures . Conclusions : These results do not support the hypothesis that the introduction of an educational package and a written guided self-management plan to the parents of pre-school children with asthma who had recently attended hospital for troublesome asthma or wheeze reduces morbidity over the subsequent 12 months BACKGROUND The aim of this study was to compare the effectiveness of an intensive asthma education program ( group B ) with that of a st and ard asthma education program ( group A ) . METHODS A prospect i ve r and omized single blinded study was conducted in the pediatric department of a public hospital in Hong Kong . Children aged 2 - 15 years admitted to the pediatric department with an acute attack of asthma were recruited . A st and ard asthma education program ( group A ) or an intensive asthma education program ( group B ) for children were offered . The main outcome measures include the number of visits to the emergency department and the number of hospitalization for asthma during the 3 month follow-up period . RESULTS A total of 45 children were in group A and 55 in group B. Group B had statistically significant reductions in the number of visits to the emergency department and the number of hospitalizations . Drug compliance was also significantly improved in group B. Parents ' satisfaction rate was also higher in group B. CONCLUSION The intensive asthma education program might be more cost effective than the st and ard asthma education program in the management of asthmatic children admitted to hospital in Hong Kong PURPOSE Many asthmatic patients discharged from emergency departments do not have timely follow-up visits with a primary care physician . This study was conducted to determine the effectiveness of a health professional-based intervention in improving process of care and health outcomes among asthmatic patients discharged from emergency departments . METHODS We enrolled 125 asthmatic patients , aged 5 through 50 years , from the emergency department of a community-based hospital ; 62 patients were assigned to usual care and 63 to enhanced care . Enhanced care consisted of usual care plus employment of a coordinator to make follow-up appointments with the patient 's primary care physician with at least one reminder telephone call to the patient . RESULTS At 6 months of follow-up , mean ( + /- SD ) asthma and pediatric quality -of-life scores were higher in the enhanced care group than in the usual care group ( 5.7 + /- 1.2 units vs. 5.0 + /- 1.3 units , P = 0.01 ) . The enhanced care group also had a higher rate of follow-up office visits ( 78 % [ n = 44 ] vs. 60 % [ n = 33 ] , P = 0.003 ) , were more likely to have written action plans ( 46 % [ n = 26 ] vs. 25 % [ n = 14 ] , P = 0.02 ) , and had fewer asthma symptoms ( 1.8 + /- 1.1 units vs. 2.2 + /- 1.3 units , P = 0.09 ) . However , these differences disappeared by 12 months of follow-up . CONCLUSION A simple intervention wherein a health professional facilitates follow-up visits can improve the process of care and health outcomes of high-risk asthmatic patients . However , the effect of this intervention is time limited and largely wears off by 12 months Background Chronic illness is a significant driver of the global burden of disease and associated health care costs . People living with severe chronic illness are heavy users of acute hospital services ; better coordination of their care could potentially improve health outcomes while reducing hospital use . The Care Navigation trial will evaluate an in-hospital coordinated care intervention on health service use and quality of life in chronically ill patients . Methods / Design A r and omised controlled trial in 500 chronically ill patients presenting to the emergency department of a hospital in Western Sydney , Australia . Participants have three or more hospital admissions within a previous 12 month period and either aged ≥70 years ; or aged ≥45 years and of Aboriginal or Torres Strait Isl and er descent ; or aged ≥ 16 with a diagnosis of a respiratory or cardiology related illness . Patients are r and omised to either the coordinated care program ( Care Navigation ) , or to usual care . The Care Navigation program consists of dedicated nurses who conduct patient risk assessment s , oversee patient nursing while in hospital , and guide development of a care plan for the management of chronic illness after being discharged from hospital . These nurses also book community appointments and liaise with general practitioners . The main outcome variables are the number of emergency department re-presentations and hospital readmissions , and quality of life during a 24 month follow-up . Secondary outcomes are length of hospital stay , mortality , time to first hospital re-admission , time to first emergency department re-presentation , patient satisfaction , adherence to prescribed medications , amount and type of in-hospital referrals made for consultations and diagnostic testing , and the number and type of community health referrals . A process evaluation and economic analysis will be conducted alongside the r and omised trial . Discussion A trial of in-hospital care coordination may support recent evidence that engaging primary health services in care plans linked to multidisciplinary team support improves patient outcomes and reduces costs to the health system . This will inform local , national and international health policy . Trial registration Australia New Zeal and Clinical Trials Registry OBJECTIVES To test the hypothesis that reinforcement of the advice given at the time of discharge from the emergency department by telephone consultation would improve asthma outcomes . METHODS A r and omized controlled trial of the parents of 310 children who had been discharged from the emergency department with asthma was undertaken . The parents were r and omized to receive either st and ard care ( 155 children ) or st and ard care plus education by telephone ( 155 children ) from a trained asthma educator . Symptoms , parental asthma knowledge , parental quality of life and use of asthma action plans and preventer therapy were collected at baseline and 6 months later . The primary measure was days of wheeze in last 3 months ; intermediate measures were regular use of preventer medications , possession and use of written asthma action plan , parental asthma knowledge scores and parental quality of life scores . RESULTS A total of 266 parents ( 136 intervention ) completed the follow-up question naires after 6 months . Both groups showed similar symptoms and process measures at baseline , apart from more regular use of preventer medication in the control children . At follow up , the intervention group children were significantly more likely than controls to possess ( 87.5 % vs 72.3 % ; P = 0.002 ) a written asthma action plan . Possession of action plans increased from baseline in the intervention group but tended to decrease in the control group . Use of action plans was greater in the intervention group but decreased from baseline in both groups . Both intervention and control groups showed significant decreases in asthma symptoms . CONCLUSIONS Reinforcement by telephone consultation did not improve the primary outcome of wheeze in the last 3 months . However , it increased the possession and regular use of written asthma action plans in the intervention group Care of asthmatic children is often episodic and more therapeutic than preventive . A 2-year r and omized , controlled trial involving 95 children measured the impact of a comprehensive home and ambulatory program for pediatric asthma management using objective outcome measures . Interventions for the study group during the first year included 3-month clinic visits , education , and home visits by a specially trained research nurse . Control subjects continued to receive regular care from a family physician or pediatrician . Eight-nine subjects ( 93 % ) completed the study . Study subjects had less school absenteeism than control subjects ( 10.7 vs. 16.0 days , P = .04 ) and showed significantly better small airway function after 1 year . Asthma severity improved in 13 study subjects and worsened in 5 . The reverse was true for control subjects . Study subjects exhibited better metered aerosol technique than control subjects ( P = .0005 ) . Fewer days were spent in hospital by the study subjects admitted compared with control subjects ( 3.67 vs 11.2 days , P = .02 ) . After 1 year , more study than control families ( 72.1 % vs 33.1 % , P = .006 ) reported that their asthmatic child took responsibility for the asthma management . The intervention failed to reduce exposure to secondh and smoke or to household pets . There were no significant differences in medical visits , theophylline levels , or records of asthma symptoms . One year after discontinuing the intervention , a marked " washout " effect was observed . Comprehensive ambulatory programs of childhood asthma management can improve objective measures of illness severity but must be sustained A r and omised controlled study of an educational programme for children with asthma and their families was carried out by community child health nurses . Three hundred and sixty eight children aged 2 to 14 years were enrolled in the study after admission to hospital for asthma . The intervention group was visited monthly by a nurse for six months . The subjects were assessed six months later by a postal , self administered question naire . European children in the intervention group were taking significantly more drugs for the treatment of asthma six months after the index admission to hospital than those in the control group ( mean ( SD ) intake 2.7 ( 1.1 ) v 2.1 ( 1.0 ) , respectively ) . In particular , they were using more theophylline ( 56.6 % v 37.0 % ) and inhaled steroids ( 34.9 % v 21.0 % ) . There was no difference between the groups for parental reports of improvement , of missed schooling , and in severe attacks of asthma of not responding to the usual treatment at home . European children in the intervention group used the hospital services for severe attacks of asthma more than controls ( 34.2 % v 10.5 % ) . There were more re-admissions in the European intervention group in the subsequent six months after the index admission than in the control group ( mean ( SD ) 0.51 ( 0.97 ) v 0.29 ( 0.65 ) . Re-admission continued to be higher in the 12 months after the nurse had stopped visiting ( 0.81 ( 1.65 ) v 0.25 ( 0.65 ] . There was no difference in the duration of hospital stay between the intervention and control groups . For Polynesian children there was no difference between the groups for any outcome measures Effective self-management and treatment compliance is important in achieving good symptom control in asthma . The aim of this study was to determine whether asthma nurse intervention during hospital admission could increase knowledge and improve self-management and whether this would influence the number of emergency call-out visits by Genera Practitioners ( GPs ) and hospital re-admissions . Patients with acute asthma ( n=80 ) were assessed by the asthma nurse within 24 h of admission using a British Thoracic Society ( BTS ) guideline -based question naire . Main outcome measures were : know edge of inhalers , self-management plans , peak flow monitoring , recognition of worsening symptoms and appropriate emergency action , Following r and omization , half received nurse intervention during hospitalization . All received a follow-up question naire 6 weeks post-discharge and again at 6 months ( response rates 86 % and 81 % respectively ) . GPs were contacted by postal question naire after 4 months . Question naire responses indicated an increase in knowledge in the intervention group , along with an ability to identify appropriate action on worsening symptoms . Emergency GP call-outs were more frequent in the control group in the 4 months post-discharge . Hospital re-admission rates were similar in both groups . Asthma nurse intervention appeared to increase knowledge of asthma management , maintained throughout the study period , but had no significant impact on reducing re-admissions to hospital BACKGROUND Re-admissions to hospital in childhood asthma are common with studies reporting that 25 % or more of children will be re-admitted within a year . There is a need for strategies to reduce re-admissions . METHODS A prospect i ve r and omised control study of an asthma home management training programme was performed in children aged two years or over admitted with acute asthma . Two hundred and one children were r and omised at admission to either an intervention group ( n = 96 ) which received the teaching programme or a control group ( n = 105 ) . A nurse-led teaching programme used the current attack as a model for the management of future attacks and included discussion , written information , subsequent follow up and telephone advice aim ed at developing and reinfor Output:

AUTHORS ' CONCLUSIONS Current evidence suggests that individual caseworker-assigned discharge plans , as compared to non-caseworker-assigned plans , may be beneficial in preventing hospital readmissions for acute exacerbations in children with asthma . There was no clear indication that the intervention reduces emergency department and general practitioner attendances for asthma , and there is an absence of data for children with other chronic respiratory conditions .

MS2_1shot499

***TASK*** the task is to summarize an input biomedical literature in six sentences ***INPUT*** the input is a biomedical literature ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences ***DOCUMENTATION*** ***EXAMPLES*** Input: To investigate the frequency and risk factors of major depressive disorder ( MDD ) after mild to moderate traumatic brain injury ( TBI ) , 69 TBI and 52 general trauma ( GT ) patients were prospect ively recruited and studied at 3-months postinjury . There was a nonsignificant difference in the proportion of MDD patients in the TBI and GT groups . Therefore , a composite MDD group ( TBI and GT patients ) was compared to patients who were nondepressed . Female gender was related to MDD , but no other risk factors were identified . MDD was associated with disability ( Glasgow Outcome Scale , Community Integration Question naire ) and cognitive impairment . MDD was comorbid with posttraumatic stress disorder . Implication s for postacute management of mild to moderate TBI are discussed OBJECTIVE To conduct a prospect i ve study of the occurrence of psychological disorders and comorbidities after spinal cord injury ( SCI ) , determine psychotropic medication usage , and establish predictors of psychological disorders after transition to the community . DESIGN Longitudinal design with multiple measures . SETTING Assessment occurred in SCI units and the community . PARTICIPANTS Adults with SCI ( N=88 ) admitted over a period of 32 months into 3 SCI units . INTERVENTIONS Participants completed inpatient rehabilitation for an acute SCI . Longitudinal assessment occurred up to 6 months postdischarge . MAIN OUTCOME MEASURES Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI . The Mini International Neuropsychiatric Interview , a structured diagnostic psychiatric interview , was conducted to determine the presence of psychological disorders . Medical measures included severity of secondary conditions or complications . Psychological measures included measures of anxiety and depressive mood , resilience , pain catastrophization , self-efficacy , and cognitive capacity . RESULTS Rates of psychological disorders of 17 % to 25 % were substantially higher than rates found in the Australian community . The occurrence of psychological disorder comorbidities was also very high . Anxiety was significantly elevated in those with a psychological disorder . Psychotropic medications were prescribed to more than 36 % of the sample , with most being antidepressants . Factors predictive of psychological disorders included years of education , premorbid psychiatric/psychological treatment , cognitive impairment , secondary complications , resilience , and anxiety . CONCLUSIONS SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge . Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community . Additional re sources should be invested in improving the mental health of adults with SCI Background There is considerable evidence showing that injured people who are involved in a compensation process show poorer physical and mental recovery than those with similar injuries who are not involved in a compensation process . One explanation for this reduced recovery is that the legal process and the associated retraumatization are very stressful for the cl aim ant . The aim of this study was to empower injured cl aim ants in order to facilitate recovery . Methods Participants were recruited by three Dutch cl aims settlement offices . The participants had all been injured in a traffic crash and were involved in a compensation process . The study design was a r and omized controlled trial . An intervention website was developed with ( 1 ) information about the compensation process , and ( 2 ) an evidence -based , therapist-assisted problem-solving course . The control website contained a few links to already existing websites . Outcome measures were empowerment , self-efficacy , health status ( including depression , anxiety , and somatic symptoms ) , perceived fairness , ability to work , cl aims knowledge and extent of burden . The outcomes were self-reported through online question naires and were measured four times : at baseline , and at 3 , 6 , and 12 months . Results In total , 176 participants completed the baseline question naire after which they were r and omized into either the intervention group ( n = 88 ) or the control group ( n = 88 ) . During the study , 35 participants ( 20 % ) dropped out . The intervention website was used by 55 participants ( 63 % ) . The health outcomes of the intervention group were no different to those of the control group . However , the intervention group considered the received compensation to be fairer ( P < 0.01 ) . The subgroup analysis of intervention users versus nonusers did not reveal significant results . The intervention website was evaluated positively . Conclusions Although the web-based intervention was not used enough to improve the health of injured cl aim ants in compensation processes , it increased the perceived fairness of the compensation amount . Trial registration Netherl and s Trial Register OBJECTIVE To compare differences in functional outcomes between urban and rural patients with traumatic brain injury ( TBI ) . DESIGN A longitudinal , prospect i ve , multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program ( BIRP ) for New South Wales , with follow-up at 18 months after injury . PARTICIPANTS 198 patients ( 147 urban , 51 rural ) with severe TBI from the 11 participating rehabilitation units . MAIN OUTCOME MEASURES Demographic and injury details collected prospect ively using a st and ardised question naire , and measures from five vali date d instruments ( Disability Rating Scale , Mayo-Portl and Adaptability Inventory , Sydney Psychosocial Reintegration Scale , Medical Outcomes Study Short Form and the General Health Question naire--28-item version ) administered at follow-up to document functional , psychosocial , emotional and vocational outcomes . RESULTS Demographic details , injury severity , lengths of stay in intensive and acute care wards were similar for both rural and urban groups . There were no significant group differences in functional outcomes , including return to work , at follow-up . CONCLUSIONS Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents , and suggest that the integrated network of inpatient , outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live & NA ; Psychological distress is a feature of chronic whiplash‐associated disorders , but little is known of psychological changes from soon after injury to either recovery or symptom persistence . This study prospect ively measured psychological distress ( General Health Question naire 28 , GHQ‐28 ) , fear of movement/re‐injury ( TAMPA Scale of Kinesphobia , TSK ) , acute post‐traumatic stress ( Impact of Events Scale , IES ) and general health and well being ( Short Form 36 , SF‐36 ) in 76 whiplash subjects within 1 month of injury and then 2 , 3 and 6 months post‐injury . Subjects were classified at 6 months post‐injury using scores on the Neck Disability Index : recovered ( < 8 ) , mild pain and disability ( 10–28 ) or moderate/severe pain and disability ( > 30 ) . All whiplash groups demonstrated psychological distress ( GHQ‐28 , SF‐36 ) to some extent at 1 month post‐injury . Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post‐injury , parallelling a decrease in reported pain and disability . Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms . The moderate/severe and mild groups showed elevated TSK scores at 1 month post‐injury . TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms . Elevated IES scores , indicative of a moderate post‐traumatic stress reaction , were unique to the group with moderate/severe symptoms . The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside . Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post‐traumatic stress reaction Abstract Dysregulations of the hypothalamus – pituitary – adrenal ( HPA ) axis have been discussed as a physiological substrate of chronic pain and fatigue . The aim of the study was to investigate possible dysregulations of the HPA axis in chronic whiplash‐associated disorder ( WAD ) . In 20 patients with chronic WAD and 20 healthy controls , awakening cortisol responses as well as a short circadian free cortisol profile were assessed before and after administration of 0.5 mg dexamethasone . In comparison to the controls , chronic WAD patients had attenuated cortisol responses to awakening , normal cortisol levels during the day , and showed enhanced and prolonged suppression of cortisol after the administration of 0.5 mg dexamethasone . Dysregulations of the HPA axis in terms of reduced reactivity and enhanced negative feedback suppression exist in chronic WAD . The observed endocrine abnormalities could serve as a systemic mechanism of symptoms experienced by chronic WAD patients The question as to whether mild traumatic brain injury ( mTBI ) results in persisting sequelae over and above those experienced by individuals sustaining general trauma remains controversial . This prospect i ve study aim ed to document outcomes 1 week and 3 months post-injury following mTBI assessed in the emergency department ( ED ) of a major adult trauma center . One hundred and twenty-three patients presenting with uncomplicated mTBI and 100 matched trauma controls completed measures of post-concussive symptoms and cognitive performance ( Immediate Post-Concussion Assessment and Cognitive Testing battery ; ImPACT ) and pre-injury health-related quality of life ( SF-36 ) in the ED . These measures together with measures of psychiatric status ( the Mini-International Neuropsychiatric Interview [ MINI ] ) pre- and post-injury , the Hospital Anxiety and Depression Scale , Visual Analogue Scale for Pain , Functional Assessment Question naire , and PTSD Checklist-Specific , were re-administered at follow-up . Participants with mTBI showed significantly more severe post-concussive symptoms in the ED and at 1 week post-injury . They performed more poorly than controls on the Visual Memory subtest of the ImPACT at 1 week and 3 months post-injury . Both the mTBI and control groups recovered well physically , and most were employed 3 months post-injury . There were no significant group differences in psychiatric function . However , the group with mild TBI was more likely to report ongoing memory and concentration problems in daily activities . Further investigation of factors associated with these ongoing problems is warranted OBJECTIVE To conduct a descriptive study investigating the effect of access to motor vehicle accident ( MVA ) compensation on recovery outcomes at 24 months after injury . DESIGN AND SETTING Longitudinal cohort study conducted in two Level 1 trauma hospitals in Victoria , Australia . Participants were 391 r and omly selected injury patients with moderate-to-severe injuries . Compensable and non-compensable patients were compared at 24 months after injury on a number of health outcomes . MAIN OUTCOME MEASURES Health outcomes at 24 months , including anxiety and depression severity , quality of life and disability . RESULTS Medical records identified two groups of compensation patients : MVA-compensable and non-compensable patients . After controlling for baseline variables , the MVA-compensable patients , at 24 months , had higher levels of post-traumatic stress disorder , anxiety and depression , and were less likely to have returned to their pre-injury number of work hours . However , some patients in the non-compensable group had accessed other forms of compensation ( eg , private health care or compensation for victims of crime ) . When these were removed from the non-compensable group , the differences between MVA-compensable and non-compensable groups all but disappeared . CONCLUSION Our findings do not Output: Increased psychological distress remains elevated in SCI , mTBI and WAD for at least 3 years post-MVC . Input: Introduction A better underst and ing of pediatric antiretroviral therapy ( ART ) adherence in sub-Saharan Africa is necessary to develop interventions to sustain high levels of adherence . Methodology /Principal Findings Adherence among 96 HIV-infected Zambian children ( median age 6 , interquartile range [ IQR ] 2,9 ) initiating fixed-dose combination ART was measured prospect ively ( median 23 months ; IQR 20,26 ) with caregiver report , clinic and unannounced home-based pill counts , and medication event monitoring systems ( MEMS ) . HIV-1 RNA was determined at 48 weeks . Child and caregiver characteristics , socio-demographic status , and treatment-related factors were assessed as predictors of adherence . Median adherence was 97.4 % ( IQR 96.1,98.4 % ) by visual analog scale , 94.8 % ( IQR 86,100 % ) by caregiver-reported last missed dose , 96.9 % ( IQR 94.5,98.2 % ) by clinic pill count , 93.4 % ( IQR 90.2,96.7 % ) by unannounced home-based pill count , and 94.8 % ( IQR 87.8,97.7 % ) by MEMS . At 48 weeks , 72.6 % of children had HIV-1 RNA < 50 copies/ml . Agreement among adherence measures was poor ; only MEMS was significantly associated with viral suppression ( p = 0.013 ) . Predictors of poor adherence included changing residence , school attendance , lack of HIV disclosure to children aged nine to 15 years , and increasing household income . Conclusions / Significance Adherence among children taking fixed-dose combination ART in sub-Saharan Africa is high and sustained over two years . However , certain groups are at risk for treatment failure , including children with disrupted routines , no knowledge of their HIV diagnosis among older children , and relatively high household income , possibly reflecting greater social support in the setting of greater poverty Background For youth living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome ( AIDS ) , nonadherence to antiretroviral therapy ( ART ) can lead to poor health outcomes and significantly decreased life expectancy . Objective To evaluate the feasability , acceptability , and preliminary efficacy of short message service ( SMS ) or text message reminders to improve adherence to ART for youth living with HIV/AIDS . Methods We conducted this prospect i ve pilot study using a pre – post design from 2009 to 2010 at a community-based health center providing clinical services to youth living with HIV/AIDS . Eligibility criteria included HIV-positive serostatus , age 14–29 years , use of a personal cell phone , English-speaking , and being on ART with documented poor adherence . During the 24-week study period , participants received personalized daily SMS reminders and a follow-up message 1 hour later assessing whether they took the medication , and asking participants to respond via text message with the number 1 if they took the medication and 2 if they did not . Outcome measures were feasibility , acceptability , and adherence . Self-reported adherence was determined using the visual analog scale ( VAS ) and AIDS Clinical Trial Group ( ACTG ) question naire 4-day recall . Viral load and CD4 cell count were followed as biomarkers of adherence and disease progression at 0 , 12 , and 24 weeks . Results Participants ( N = 25 ) were mean age 23 ( range 14–29 ) years , 92 % ( n = 23 ) male , 60 % ( n = 15 ) black , and 84 % ( n = 21 ) infected through unprotected sex . Mean VAS scores significantly increased at 12 and 24 weeks in comparison with baseline ( week 0 : 74.7 , week 12 : 93.3 , P < .001 ; week 24 : 93.1 , P < .001 ) . ACTG question naire 4-day recall also improved ( week 0 : 2.33 , week 12 : 3.24 , P = .002 ; week 24 : 3.19 , P = .005 ) . There was no significant difference in CD4 cell count or viral load between baseline and 12- or 24-week follow-up , although there was a trend toward improvement of these biomarkers and a small to moderate st and ardized effect size ( range of Cohen d : –0.51 to 0.22 ) . Of 25 participants , 21 ( 84 % ) were retained , and 20 of the 21 ( 95 % ) participants who completed the study found the intervention helpful to avoid missing doses . Conclusions In this pilot study , personalized , interactive , daily SMS reminders were feasible and acceptable , and they significantly improved self-reported adherence . Larger controlled studies are needed to determine the impact of this intervention on ART adherence and other related health outcomes for youth living with HIV/AIDS CONTEXT Physical activity has been shown to decrease the incidence of breast cancer , but the effect on recurrence or survival after a breast cancer diagnosis is not known . OBJECTIVE To determine whether physical activity among women with breast cancer decreases their risk of death from breast cancer compared with more sedentary women . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve observational study based on responses from 2987 female registered nurses in the Nurses ' Health Study who were diagnosed with stage I , II , or III breast cancer between 1984 and 1998 and who were followed up until death or June 2002 , whichever came first . MAIN OUTCOME MEASURE Breast cancer mortality risk according to physical activity category ( <3 , 3 - 8.9 , 9 - 14.9 , 15 - 23.9 , or > or = 24 metabolic equivalent task [ MET ] hours per week ) . RESULTS Compared with women who engaged in less than 3 MET-hours per week of physical activity , the adjusted relative risk ( RR ) of death from breast cancer was 0.80 ( 95 % confidence interval [ CI ] , 0.60 - 1.06 ) for 3 to 8.9 MET-hours per week ; 0.50 ( 95 % CI , 0.31 - 0.82 ) for 9 to 14.9 MET-hours per week ; 0.56 ( 95 % CI , 0.38 - 0.84 ) for 15 to 23.9 MET-hours per week ; and 0.60 ( 95 % CI , 0.40 - 0.89 ) for 24 or more MET-hours per week ( P for trend = .004 ) . Three MET-hours is equivalent to walking at average pace of 2 to 2.9 mph for 1 hour . The benefit of physical activity was particularly apparent among women with hormone-responsive tumors . The RR of breast cancer death for women with hormone-responsive tumors who engaged in 9 or more MET-hours per week of activity compared with women with hormone-responsive tumors who engaged in less than 9 MET-hours per week was 0.50 ( 95 % CI , 0.34 - 0.74 ) . Compared with women who engaged in less than 3 MET-hours per week of activity , the absolute unadjusted mortality risk reduction was 6 % at 10 years for women who engaged in 9 or more MET-hours per week . CONCLUSIONS Physical activity after a breast cancer diagnosis may reduce the risk of death from this disease . The greatest benefit occurred in women who performed the equivalent of walking 3 to 5 hours per week at an average pace , with little evidence of a correlation between increased benefit and greater energy expenditure . Women with breast cancer who follow US physical activity recommendations may improve their survival Background Mobile phone technology is a novel way of delivering health care and improving health outcomes . This trial investigates the use of motivational mobile phone text messages ( SMS ) to improve adherence to antiretroviral therapy ( ART ) over six months . Methodology /Principal Findings CAMPS was a single-site r and omized two-arm parallel design trial in Yaoundé , Cameroon . We enrolled and r and omized HIV-positive adults on ART , aged 21 years and above to receive a weekly st and ardized motivational text message versus usual care alone . The primary outcome was adherence measured using a visual analogue scale ( VAS ) , number of doses missed ( in the week preceding the interview ) and pharmacy refill data . Outcomes were measured at 3 and 6 months . Service providers and outcome assessors were blinded to allocation . Analysis was by intention-to-treat . Between November and December 2010 , 200 participants were r and omized , with 101 in the intervention group and 99 in the control group . At 6 months , overall retention was 81.5 % . We found no significant effect on adherence by VAS>95 % ( risk ratio [ RR ] 1.06 , 95 % confidence interval [ CI ] 0.89 , 1.29 ; p = 0.542 ; reported missed doses ( RR 1.01 , 95 % CI 0.87 , 1.16 ; p>0.999 ) or number of pharmacy refills ( mean difference [ MD ] 0.1 , 95 % CI : 0.23 , 0.43 ; p = 0.617 . One participant in the intervention arm reported a possible disclosure of status . Conclusions / Significance St and ardized motivational mobile phone text messages did not significantly improve adherence to ART in this study . Other types of messaging or longer term studies are recommended . Registration 1 . Pan-African Clinical Trials Registry ; PACTR201011000261458 2 . Clinical trials.gov ; Background Many HIV-infected children in sub-Saharan Africa reside in rural areas , yet most research on treatment outcomes has been conducted in urban centers . Rural clinics and residents may face unique barriers to care and treatment . Methods A prospect i ve cohort study of HIV-infected children was conducted between September 2007 and September 2010 at the rural HIV clinic in Macha , Zambia . HIV-infected children younger than 16 years of age at study enrollment who received antiretroviral therapy ( ART ) during the study were eligible . Treatment outcomes during the first two years of ART , including mortality , immunologic status , and virologic suppression , were assessed and risk factors for mortality and virologic suppression were evaluated . Results A total of 69 children entered the study receiving ART and 198 initiated ART after study enrollment . The cumulative probabilities of death among children starting ART after study enrollment were 9.0 % and 14.4 % at 6 and 24 months after ART initiation . Younger age , higher viral load , lower CD4 + T-cell percentage and lower weight-for-age z-scores at ART initiation were associated with higher risk of mortality . The mean CD4 + T-cell percentage increased from 16.3 % at treatment initiation to 29.3 % and 35.0 % at 6 and 24 months . The proportion of children with undetectable viral load increased to 88.5 % and 77.8 % at 6 and 24 months . Children with longer travel times ( ≥5 hours ) and those taking nevirapine at ART initiation , as well as children who were non-adherent , were less likely to achieve virologic suppression after 6 months of ART . Conclusions HIV-infected children receiving treatment in a rural clinic experienced sustained immunologic and virologic improvements . Children with longer travel times were less likely to achieve virologic suppression , supporting the need for de central ized models of ART delivery Introduction With the availability of antiretroviral therapy ( ART ) and primary general care for people living with HIV ( PLHIV ) in re source limited setting s , PLHIV are living longer , and HIV has been transformed into a chronic illness . People are diagnosed and started on treatment when they are relatively well . Although ART results in clinical improvement , the ultimate goal of treatment is full physical functioning and general well-being , with a focus on quality of life rather than clinical outcomes . However , there has been little research on the relationship of specific factors to quality of life in PLHIV . The objective of this study was to investigate factors associated with quality of life among PLHIV in Ug and a receiving basic care and those on ART . Methods We enrolled 1274 patients attending an HIV outpatient clinic into a prospect i ve cohort study . Of these , 640 received ART . All were followed up at 3 and 6 months . Health related quality of life was assessed with the MOS-HIV Health Survey and the Global Person Generated Index ( GPGI ) . Multivariate linear regression and logistic regression with generalized estimating equations were used to examine the relationship of social behavioral and disease factors with Physical Health Summary ( PHS ) score , Mental Health Summary ( MHS ) score , and GPGI . Results Among PLHIV receiving basic care , PHS was associated with : sex ( p=0.045 ) - females had lower PHS ; age in years at enrollment ( p=0.0001 ) - older patients had lower PHS ; and depression ( p<0.001 ) - depressed patients had lower PHS . MHS was only associated with opportunistic infection ( p=0.01 ) - presence of an opportunistic infection was associated with lower MHS . For the GPG the associated variables were age ( p=0.03 ) - older patients had lower GPGI ; education ( p= Output:

Conclusion YLWHA experience numerous challenges and support needs , some of which occur in schools and affect their QoL. The effects of these challenges are poor health and educational outcomes as well as school dropout . The schools in which youths spend most of their formative years have not provided adequate support for YLWHA .