Decrement In Scores Research Articles

Multiple Behavior Phenotypes of the Fragile-X Syndrome Mouse Model Respond to Chronic Inhibition of Phosphodiesterase-4D (PDE4D)

Fragile-X syndrome (FXS) patients display intellectual disability and autism spectrum disorder due to silencing of the X-linked, fragile-X mental retardation-1 (FMR1) gene. Dysregulation of cAMP metabolism is a consistent finding in patients and in the mouse and fly FXS models. We therefore explored if BPN14770, a prototypic phosphodiesterase-4D negative allosteric modulator (PDE4D-NAM) in early human clinical trials, might provide therapeutic benefit in the mouse FXS model. Daily treatment of adult male fmr1 C57Bl6 knock-out mice with BPN14770 for 14 days reduced hyperarousal, improved social interaction, and improved natural behaviors such as nesting and marble burying as well as dendritic spine morphology. There was no decrement in behavioral scores in control C57Bl6 treated with BPN14770. The behavioral benefit of BPN14770 persisted two weeks after washout of the drug. Thus, BPN14770 may be useful for the treatment of fragile-X syndrome and other disorders with decreased cAMP signaling.

Health-Related Quality Of Life And Rates Of Emergency Room Visits And Hospitalization In Patients With Al Amyloidosis: A Prospective Analysis

Light chain (AL) amyloidosis is a serious, complex disease that is associated with a high degree of humanistic burden and morbidity. We investigated whether health-related quality of life (HRQoL) was prospectively associated with rates of emergency room (ER) visits and hospitalization, independent of other patient characteristics. The analysis sample included patients with AL amyloidosis (n=184) from the United States, Europe, and other countries who completed three online surveys (i.e. initial, six month and twelve month follow-up) in a non-interventional, longitudinal online study. Negative binomial regression models were used to examine the association between baseline HRQoL scores (SF-36v2® Health Survey physical and mental component (PCS, MCS) summary scores) and the number (cumulative counts across both follow-ups) of ER visits and hospitalizations. Incident rate ratios (IRR) were interpreted in terms of 5 point decrements in HRQoL scores. A five-point lower PCS score was associated with a 54% greater rate of ER visits (p <0.001) and a 35% greater rate of hospitalizations (p <0.001). A five-point lower MCS score was associated with a 29% greater rate of ER visits (p <0.001) and a 34% greater rate of hospitalizations (p <0.001). Both physical and mental HRQoL impairment were significantly associated with increased rates of ER visits and hospitalizations, independent of other patient characteristics. Scores from patient-reported HRQoL surveys may serve as a proxy for disease severity and prognosis for the prediction of future ER visits and hospitalizations. Elucidating the magnitude of healthcare resource utilization in AL amyloidosis provides clinicians, scientists, and regulators an understanding of the burden of disease that these patients experience.

Early Life Inflammation and Neurodevelopmental Outcome in Bangladeshi Infants Growing Up in Adversity.

.Exposure to profound adversity can negatively affect the neurodevelopment of children, but biologic mechanisms that underlie this association remain unknown. We sought to determine whether elevated levels of the inflammatory markers C-reactive protein (CRP) and soluble CD14 (sCD14) are associated with neurodevelopmental outcomes in Bangladeshi children. A total of 422 infant–mother pairs from an urban slum in Dhaka, Bangladesh were enrolled at birth and followed prospectively. Inflammation was measured with sCD14, interleukin (IL)-1β, and IL-6 at 18 weeks, and CRP at 6, 18, 40, and 53 weeks. Psychologists assessed cognitive, language, motor, and social emotional development using the Bayley Scales of Infant and Toddler Development at 78 and 104 weeks of age. We tested for the association of inflammatory markers with developmental outcomes, independent of previously identified associations such as malnutrition, family income, and maternal education. Every 10 pg/mL increase in sCD14 was associated with a 1.1–2.0 decrement in cognitive and motor scores at 78 weeks and in all domains at 104 weeks. The cumulative number of CRP elevations that a child experienced in the first year of life, as well as IL-1β and IL-6 at 18 weeks of age, were also negatively associated with Bayley Scales results. CRP, sCD14, IL-1β, and IL-6 were associated with lower neurodevelopmental outcomes. Our findings implicate a role of inflammation in the neurodevelopment of children growing up in adversity.

The role of literacy in the association between educational attainment and depressive symptoms

There is a consistent association between education and depressive symptoms, but research on the mechanisms to explain this association remains limited. No study has formally evaluated the extent to which the association between education and depressive symptoms is mediated through a foundational skill such as literacy. Inverse odds ratio weighting (IORW) was used to estimate total, natural direct, and natural indirect effects in examining literacy as a mediator of the association between education and depressive symptoms. Health and Retirement Study participants born in the U.S. between 1900 and 1947 were interviewed biennially for up to 12 years (N = 16,718). Literacy was assessed with a brief vocabulary measure. Depressive symptoms were measured using the 8-item Centers for Epidemiologic Studies-Depression (CES-D) scale. Decomposition estimates were derived using regression analyses of repeated measures of depressive symptoms. Standard errors were obtained using a nonparametric bootstrap with the individual as the independent unit to account for dependence of observations within an individual. In a large cohort of older Americans, a one standard deviation difference in educational attainment (~ 3 years) was associated with a 0.35-point decrement in CES-D score (95% CI: -0.38, -0.32). This decrement represents a 0.22 standard deviation difference in depressive symptoms. Using IORW, the estimated effect of education on depressive symptoms mediated through literacy was -0.10 (95% CI: -0.18, -0.01), which represents 28% of the total effect. Education confers many benefits; as demonstrated by this study for depressive symptoms, one important benefit is literacy.

Health-related quality of life associated with bullying and aggression: a cross-sectional study in English secondary schools.

Associations between adolescent health-related quality of life (HRQoL), bullying, and aggression are not well understood. We used baseline data from a large-cluster randomized school trial to study the relationship between HRQoL, bullying experience, and other demographic factors. Cross-sectional self-reported questionnaires collected pre-randomization from the on-going INCLUSIVE trial. The questionnaires were completed in the classroom. The Gatehouse Bullying Scale measured bullying victimization and the Edinburgh Study of Youth Transitions and Crime school misbehavior subscale (ESYTC) measured aggressive behaviors. HRQoL was assessed using the Child Health Utility 9 Dimensions (CHU-9D) and general quality of life using the Pediatric Quality of Life Inventory (PedsQL). Participants were a cohort of year 7 students (age 11-12years) from 40 state secondary schools in England. Descriptive statistics for the CHU-9D and PedsQL were calculated using standard methods with tests for differences in median scores by sex assessed using quantile regression. Correlation between HRQoL measures was conducted using Spearman's rank correlation coefficients. Predictors of HRQoL were identified using univariate and multiple regressions. A total of 6667 students filled out the questionnaire. The CHU-9D was correlated with the PedsQL (0.63, p<0.001). The multivariable regression results suggest that if students were bullied frequently and upset it resulted in a decrement in CHU-9D scores of (-0.108) and fall in PedsQL score of (-16.2). The impact of the antisocial/aggressive behavior on the ESYTC scale resulted in a utility decrement of -0.004 and fall of -.5 on the PedsQL. Adolescents' involvement in bullying and aggression is a strong correlate of HRQoL. These data have important implications for the potential cost-effectiveness of reducing bullying and aggression in schools.

Estimating Health-State Utility Values in Kidney Transplant Recipients and Waiting-List Patients Using the EQ-5D-5L.

ObjectivesTo report health-state utility values measured using the five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) in a large sample of patients with end-stage renal disease and to explore how these values vary in relation to patient characteristics and treatment factors.MethodsAs part of the prospective observational study entitled “Access to Transplantation and Transplant Outcome Measures,” we captured information on patient characteristics and treatment factors in a cohort of incident kidney transplant recipients and a cohort of prevalent patients on the transplant waiting list in the United Kingdom. We assessed patients’ health status using the EQ-5D-5L and conducted multivariable regression analyses of index scores.ResultsEQ-5D-5L responses were available for 512 transplant recipients and 1704 waiting-list patients. Mean index scores were higher in transplant recipients at 6 months after transplant surgery (0.83) compared with patients on the waiting list (0.77). In combined regression analyses, a primary renal diagnosis of diabetes was associated with the largest decrement in utility scores. When separate regression models were fitted to each cohort, female gender and Asian ethnicity were associated with lower utility scores among waiting-list patients but not among transplant recipients. Among waiting-list patients, longer time spent on dialysis was also associated with poorer utility scores. When comorbidities were included, the presence of mental illness resulted in a utility decrement of 0.12 in both cohorts.ConclusionsThis study provides new insights into variations in health-state utility values from a single source that can be used to inform cost-effectiveness evaluations in patients with end-stage renal disease.

An experimental study on the impact of clinical interruptions on simulated trainee performances of central venous catheterization

BackgroundInterruptions are common in the healthcare setting. This experimental study compares the effects of interruptions on simulated performances of central venous catheterization during a highly versus minimally complex portion of the task.MethodsTwenty-six residents were assigned to interruptions during tasks that are (1) highly complex: establishing ultrasound-guided venous access (experimental group, n = 15) or (2) minimally complex: skin cleansing (control group, n = 11). Primary outcomes were (a) performance scores at three time points measured with a validated checklist, (b) time spent on the respective tasks, and (c) number of attempts to establish venous access.ResultsRepeated measure analyses of variances of performance scores over time indicated no main effect of time or group. The interaction between time and group was significant: F (2, 44) = 4.28, p = 0.02, and partial eta2 = 0.16, indicating a large effect size. The experimental group scores decreased steadily over time, while the control group scores increased with time. The experimental group required longer to access the vein (148 s; interquartile range (IQR) 60 to 361 vs. 44 s; IQR 27 to 133 s; p = 0.034). Median number of attempts to establish venous access was higher in the experimental group (2, IQR 1–7 vs. 1, IQR 1–2; p = 0.03).ConclusionsInterruptions during a highly complex task resulted in a consistent decrement in performance scores, longer time required to perform the task, and a higher number of venous access attempts than interruptions during a minimally complex tasks. We recommend avoiding interrupting trainees performing bedside procedures.

Comparison between ultrasound-guided interfascial pulsed radiofrequency and ultrasound-guided interfascial block with local anesthetic in myofascial pain syndrome of trapezius muscle.

Myofascial pain syndrome (MPS) of the trapezius muscle (TM) is a frequently occurring musculoskeletal disorder. However, the treatment of MPS of the TM remains a challenge. We investigated the effects of ultrasound (US)-guided pulsed radiofrequency (PRF) stimulation on the interfascial area of the TM. In addition, we compared its effect with that of interfascial block (IFB) with 10 mL of 0.6% lidocaine on the interfascial area of the TM. Thirty-six patients with MPS of the TM were included and randomly assigned into 2 groups. Eighteen patients underwent PRF stimulation on the interfascial area of the TM (PRF group) and 18 patients underwent IFB with lidocaine on the same area (IFB group). Pain intensity was evaluated using a numerical rating scale (NRS) at pretreatment, 2, 4, and 8 weeks after treatment. At pretreatment and 8 weeks after treatment, quality of life was assessed using the Short Form-36 Health Survey (SF-36), which includes the physical component score (PCS) and the mental component score (MCS). One patient in the PRF group was lost to follow-up. Patients in both groups showed a significant decrease in NRS scores at 2, 4, and 8 weeks after treatments and a significant increase in PCS and MCS of the SF-36 at 8 weeks after treatments. Two weeks after each treatment, the decrements of NRS scores were not significantly different between the 2 groups. However, 4 and 8 weeks after the procedures, we found that the NRS score was significantly lower in the PRF group than in the IFB group. At 8 weeks after the treatments, PCS and MCS of the SF-36 in the PRF group were significantly higher than those in the IFB group. For the management of MPS of the TM, US-guided interfascial PRF had a better long-term effect on reducing the pain and the quality of life compared to US-guided IFB. Therefore, we think US-guided PRF stimulation on the interfascial area of the TM can be a beneficial alternative to manage the pain following MPS of the TM.

Pain, Pressure Pain Threshold and Disability Following One Session of Dry Needling in Subjects with Active Trigger Points in the Upper Trapezius Muscle

Introduction: Myofascial pain syndrome is a common, non-articular musculoskeletal disorder characterized by local tenderness and referral pain due to the active trigger points in muscles. The aim of this study was to evaluate the effects of one session of dry needling in subjects with active trigger points in upper trapezius muscle. Materials and Methods: 23 subjects with active trigger points in upper trapezius muscle participated in the study. The pain intensity and Disability Index were measured using visual analogue scale (VAS) and Neck Disability Index questionnaire, respectively. All data were measured before and one week after the intervention. Using algometry, the pressure pain threshold was also measured immediately after the dry needling. Results: There were significant differences in mean pressure pain threshold among the three measurements (P < 0.001). The pressure pain threshold significantly decreased immediately after the intervention (P = 0.001); although it significantly increased a week later compared to before the intervention (P = 0.001). There was significant decrement in the mean Disability Index score and pain intensity after the intervention (P < 0.001). Conclusion: One week after one session of dry needling, disability, pain intensity and pressure pain threshold improved considerably in subjects suffering from active trigger points in upper trapezius muscle.

A influência de variáveis aeróbias e anaeróbias no teste de “sprints” repetidos

Resumo O objetivo deste estudo foi determinar o modo e o grau com que variáveis aeróbias e anaeróbias influenciam o desempenho e a fadiga em “sprints” repetidos (RS) na corrida. Para este fim, participaram do estudo 24 homens, sendo oito corredores velocistas, oito corredores fundistas e oito sujeitos ativos. Em uma pista sintética de atletismo estes sujeitos foram submetidos aos seguintes testes: 1) teste incremental para determinação do VO2max e da velocidade aeróbia máxima (VAM); 2) teste de velocidade constante realizado a 110%VAM para determinar a cinética do VO2 durante exercício e o máximo déficit acumulado de oxigênio (MAOD); 3) teste de “sprints” repetidos (10 “sprints” de 35 m, intercalados com 20 s de recuperação) para determinar o tempo total dos “sprints” (TT), tempo do melhor sprint (TM) e a queda do desempenho em percentual (Sdec). Para analisar a diferença entre os grupos e as relações entre as variáveis foram utilizadas a análise de variância ANOVA “one-way”, complementada pelo teste de Tukey, e a correlação de Pearson, respectivamente. O TT em RS foi diferente significativamente entre todos os grupos (velocistas, 49,5 ± 0,8 s; fundistas, 52,6 ± 3,1 s; ativos, 55,5 ± 2,6 s) e Sdec foi significativamente inferior em fundistas comparado aos outros grupos (velocistas, 8,9 ± 2,1%; fundistas, 4,0 ± 2,0%; ativos, 8,4 ± 4,4%). O TT foi correlacionado significativamente com o TM (r = 0,85, p &lt; 0,01) e com o MAOD (r = −0,54, p &lt; 0,01). Além disso, Sdec foi correlacionado significativamente com variáveis aeróbias (VO2max, r = −0,58, p &lt; 0,01; VAM, r = −0,59, p &lt; 0,01; constante de tempo “tau”, r = 0,45, p = 0,03). Portanto, conclui-se que apesar de índices aeróbios influenciarem na redução da fadiga em RS, o desempenho em RS é principalmente influenciado por características anaeróbias.

Plan quality and dosimetric association of patient-reported rectal and urinary toxicities for prostate stereotactic body radiotherapy

Background and purposeTo study the association between dosimetric parameters with patient-reported quality-of-life (QOL) in urinary irritative/incontinency and bowel functions for prostate stereotactic body radiotherapy (SBRT). Material and methodsThe patient-reported QOL was evaluated using the Expanded Prostate Cancer Index Composite (EPIC-26). According to the progression in QOL score over 12months, patients were assigned to one of three subgroups: score decrement, no change, or increment. The dosimetric parameters were cross-compared among subgroups in urinary and bowel domains using univariate Analysis of Variance (ANOVA). The evaluated dosimetric metrics included target volume, V100 (volume receiving 100% prescription dose); rectal volume/dose–volume endpoints, maximum/mean doses; bladder volume/dose–volume endpoints, and maximum/mean doses. ResultsPatients with consistent QOL reduction in urinary irritation function were significantly associated with greater mean bladder dose, greater V85/V90/V95/V100 and D2cc/D10cc. Patients with QOL reduction in urinary incontinence were marginally associated with greater mean bladder dose (p=0.06). None of the evaluated dosimetric parameters showed a significant correlation with QOL score change in bowel function. ConclusionsPatients with large prostate size were more susceptible to QOL decrements for urinary irritative and incontinency functions. Large bladder V85/V90/V95/V100 was associated with QOL decrements in the urinary irritative domain at 1-year after prostate SBRT.

Effects of Threshold Adjustment on Speech Perception in Nucleus Cochlear Implant Recipients.

The objective of this study was to investigate the impact of using smaller and larger electric dynamic ranges on speech perception, aided thresholds, and subjective preference in cochlear implant (CI) subjects with the Nucleus device. Data were collected from 19 adults using the Nucleus CI system. Current levels (CLs) used to set threshold stimulation levels (T-levels) were set above or below the measured hearing thresholds to create smaller or larger electric output dynamic ranges, respectively, whereas the upper stimulation level (C-level) was fixed. The base (unadjusted) condition was compared against two conditions with higher T-levels (compression), by 30% and 60% of the measured hearing dynamic range, and three conditions with lower T-levels (expansion), by 30%, 60%, and 90% of the measured hearing dynamic range. For each subject, the clinical CL units were adjusted on each electrode to achieve these conditions. The slow-acting dynamic acoustic gains of ADRO and Autosensitivity™ were enabled. Consonant-nucleus-consonant (CNC) word scores were measured in quiet at 50 dB and 60 dB SPL presentation levels. The signal-to-noise ratios (SNRs) for 50% understanding of sentences in noise were measured for sentences presented at 55 dB and 65 dB SPL in 4-talker babble noise. Free-field aided thresholds were measured at octave frequencies using frequency-modulated (warble) tones. Thirteen of the 19 subjects had take-home experience with the base and experimental conditions and provided subjective feedback via a questionnaire. There were no significant effects of 30% expansion and 30% compression of the electric dynamic range on scores for words in quiet and SNRs for sentences in noise, at the two presentation levels. There was a significant decrement in scores for words in quiet for 60% and 90% expansion compared with the base condition at the 50 dB and 60 dB SPL presentation levels. The score decrement was much less at 60 dB SPL. For the 50 dB SPL presentation level, the decrements in word scores at 60% and 90% expansion were linearly related to the reduction in CL units required to achieve these experimental conditions, with a greater decrement in scores for a larger CL change. There was a significant increase in SNR for sentences in noise for 60% compression compared with the base condition at the 55 dB and 65 dB SPL presentation levels. There was also a significant increase in SNR for sentences at the 55 dB SPL presentation level for 90% expansion. Aided thresholds were significantly elevated for the three expansion conditions compared with the base condition, although the mean elevation at 30% expansion was only 4 dB. The questionnaire results showed no clear preference for any condition; however, subjects reported a reduced preference for the extreme compression (60%) and expansion (90%) conditions. The results showed that CI subjects using the Nucleus sound processor had no significant change in performance or preference for adjustments in T-levels by ±30% of the hearing dynamic range. In quiet, speech perception scores were reduced for the more marked expansion (60% and 90%) conditions, whereas in noise, performance was poorer for the highest compression (60%) condition. Across subjects, the decrement in scores for words at 50 dB SPL for the 60% and 90% expansion conditions was related to the changes in CL units required for these conditions, with greater decrements for larger changes in levels.

Low-level arsenic exposure and developmental neurotoxicity in children: A systematic review and risk assessment

Risk assessments of arsenic have focused on skin, bladder, and lung cancers and skin lesions as the sensitive cancer and non-cancer health endpoints, respectively; however, an increasing number of epidemiologic studies that can inform risk assessment have examined neurodevelopmental effects in children. We conducted a systematic review and risk assessment based on the epidemiologic literature on possible neurodevelopmental effects at lower arsenic exposures. Twenty-four cross-sectional, case-control, and cohort studies were identified that report on the association between low-level arsenic exposure (i.e., largely <100 μg/L of arsenic in drinking water) and neurological outcomes in children. Although the overall evidence does not consistently show a causal dose-response relationship at low doses, the most rigorously conducted studies from Bangladesh indicate possible inverse associations with cognitive function, predominantly involving concurrent arsenic exposure as measured by biomarkers (i.e., arsenic in urine or blood) and raw verbal test scores at ages 5-11 years. Issues such as non-comparability of outcome measures across studies; inaccuracies of biomarkers and other measures of inorganic arsenic exposure; potential effect modification by cultural practices; insufficient adjustment for nutritional deficiencies, maternal IQ, and other important confounders; and presence of other neurotoxicants in foreign populations limit generalizability to U.S. Of the few U.S. studies available, the most rigorously conducted study did not find a consistent dose-response relationship between arsenic concentrations in tap water or toenails and decrements in IQ scores. Assuming that the strongest dose-response relationship from the most rigorous evidence from Bangladesh is generalizable to U.S. populations, possible reference doses were estimated in the range of 0.0004-0.001 mg/kg-day. These doses are higher than the U.S. Environmental Protection Agency reference dose for chronic lifetime exposure, thus indicating protectiveness of the existing value for potential neurotoxicity in children. This reference dose is undergoing revision as EPA considers various health endpoints in the reassessment of inorganic arsenic health risks.

Prevalence, management and outcomes of medically complex vulnerable elderly patients with urinary incontinence in the United States.

SummaryObjectivesTo assess the prevalence, patient–physician communication, treatment and health outcomes associated with urinary incontinence (UI) among the medically complex vulnerable elderly (MCVE) in the United States (US).MethodsData from the 2006 to 2012 Medicare Health Outcomes Survey (HOS) were used. MCVE patients were aged 65+ years with a HOS VE score ≥ 3. UI was reported as a small, big or no problem. Descriptive statistics were used to assess patient–physician communication and treatment. Multivariable regression analyses were performed to assess the association of small or big UI problems with various outcomes.ResultsThe annual UI prevalence increased among MCVE [from 35.8% (2006) to 38.6% (2012)]. MCVE with big UI problems communicated with their physicians more often than those with small UI problems (77.9% and 49.6%, respectively); however, treatment of UI remained low (48.5% and 29.1%, respectively). Physical component summary (PCS) and mental component summary (MCS) scores were lower among MCVE with small or big UI problems compared with those with no UI problems, respectively. The decrements in PCS and MCS scores associated with big UI problems were greater than the decrements associated with any of the other assessed conditions. MCVE with small or big UI problems, respectively, were more likely to report past falls, depression and activity daily living limitations vs. those without UI. The odds of having experienced these outcomes were greater for those with big UI vs. small UI problems.ConclusionsUrinary incontinence prevalence in the USA increased among MCVE from 2006 to 2012, although treatment of UI remained low. UI problems, particularly big UI problems, adversely impact health outcomes. Efforts to better identify and manage UI among the MCVE are needed.

Ability of Bottle Cap Color to Facilitate Accurate Patient–Physician Communication Regarding Medication Identity in Patients with Glaucoma

To determine the accuracy of patient-physician communication regarding topical ophthalmic medication use based on bottle cap color, particularly among individuals who may have acquired color vision deficiency from glaucoma. Cross-sectional, clinical study. Patients aged ≥18 years with primary open-angle, primary angle-closure, pseudoexfoliation, or pigment dispersion glaucoma, bilateral visual acuity of ≥20/400, and no concurrent conditions that may affect color vision. A total of 100 patients provided color descriptions of 11 distinct medication bottle caps. Color descriptors were then presented to 3 physicians. Physicians matched each color descriptor to the medication they thought the descriptor was describing. Frequency of patient-physician agreement, occurring when all 3 physicians accurately matched the color descriptor to the correct medication. Multivariate regression models evaluated whether patient-physician agreement decreased with degree of better-eye visual field (VF) damage, color descriptor heterogeneity, or color vision deficiency, as determined by the Hardy-Rand-Rittler (HRR) score and Lanthony D15 color confusion index (D15 CCI). Subjects had a mean age of 69 (±11) years, with VF mean deviation of-4.7 (±6.0) and-10.9 (±8.4) decibels (dB) in the better- and worse-seeing eyes, respectively. Patients produced 102 unique color descriptors to describe the colors of the 11 bottle caps. Among individual patients, the mean number of medications demonstrating agreement was 6.1/11 (55.5%). Agreement was less than 15% for 4 medications (prednisolone acetate [generic], betaxolol HCl [Betoptic; Alcon Laboratories Inc., Fort Worth, TX], brinzolamide/brimonidine [Simbrinza; Alcon Laboratories Inc.], and latanoprost [Xalatan; Pfizer, Inc., New York, NY]). Lower HRR scores and higher D15 CCI (both indicating worse color vision) were associated with greater VF damage (P < 0.001). Extent of color vision deficiency and color descriptor heterogeneity significantly predicted agreement in multivariate models (odds of agreement= 0.90 per 1 point decrement in HRR score, P < 0.001; odds of agreement= 0.30 for medications exhibiting high heterogeneity [≥11 descriptors], P= 0.007). Physician understanding of patient medication use based solely on bottle cap color is frequently incorrect, particularly in patients with glaucoma who may have color vision deficiency. Errors based oncommunication using bottle cap color alone may be common and could lead to confusion and harm.

Electroconvulsive therapy in mood diorders

Electroconvulsive therapy (ECT) is one of the less used somatic treatments in mood disorders, especially depressive phase. ECT use has importance during acute bipolar episode when patient extremely violent, suicidal and extreme psychomotor retardation. The aim of this study was to know about socio-demographic profile and therapeutic efficacy of the use of ECT in mood disorders. Methods: This is a prospective comparative study between patients who received ECT and who did not. Psychopathology was evaluated using Young Mania Rating Scale (YMRS) and Hamilton Depression Rating Scale (HDRS) between the groups at admission, at discharge, at 1st month, at 6th month and at 12th month. Modified ECT was performed using general anesthetic agent. Results: Twenty five patients received ECT as compared to 32 patients who were non-receivers. There was significant decrease in HDRS in ECT receiver as compared to non-receivers in patients with depression (both unipolar and bipolar) at discharge, 1st month, and 12th month; in YMRS in patient with mania at discharge, 1st month and at 12th month.Discussion: There was significant improvement in overall psychopathology and psycho-social status of patients who received ECT as compared to non-receivers. The improvement was shown by decrement in scores in HDRS and YMRS at the time of discharge, 1st month, 6th month and 1st year which were statistically significant.DOI: http://dx.doi.org/10.3126/jcmc.v4i4.11958

Montreal Cognitive Assessment for Screening Mild Cognitive Impairment: Variations in Test Performance and Scores by Education in Singapore

Background: The Montreal Cognitive Assessment (MoCA) was developed as a screening instrument for mild cognitive impairment (MCI). We evaluated the MoCA's test performance by educational groups among older Singaporean Chinese adults. Method: The MoCA and Mini-Mental State Examination (MMSE) were evaluated in two independent studies (clinic-based sample and community-based sample) of MCI and normal cognition (NC) controls, using receiver operating characteristic curve analyses: area under the curve (AUC), sensitivity (Sn), and specificity (Sp). Results: The MoCA modestly discriminated MCI from NC in both study samples (AUC = 0.63 and 0.65): Sn = 0.64 and Sp = 0.36 at a cut-off of 28/29 in the clinic-based sample, and Sn = 0.65 and Sp = 0.55 at a cut-off of 22/23 in the community-based sample. The MoCA's test performance was least satisfactory in the highest (>6 years) education group: AUC = 0.50 (p = 0.98), Sn = 0.54, and Sp = 0.51 at a cut-off of 27/28. Overall, the MoCA's test performance was not better than that of the MMSE. In multivariate analyses controlling for age and gender, MCI diagnosis was associated with a <1-point decrement in MoCA score (η² = 0.010), but lower (1-6 years) and no education was associated with a 3- to 5-point decrement (η² = 0.115 and η² = 0.162, respectively). Conclusion: The MoCA's ability to discriminate MCI from NC was modest in this Chinese population, because it was far more sensitive to the effect of education than MCI diagnosis.

Effects of Topical Honey Dressing in Decubitus Ulcer

Background: The medicinal properties of honey have been recognized since antiquity. Although used as an adjuvant method for accelerating wound healing from ancient times, honey has been sporadically used in the treatment of wounds. Many researchers have shown that honey exerts antibacterial activity against various organisms, including both Gram-positive and Gram-negative bacteria. This study was done to compare the effectiveness of honey and Povidone iodine in wound healing in Decubitus ulcers. Material &amp; Methods: We conducted a prospective hospital based study of 40 patients with bed sore. Patients were selected considering the inclusion and exclusion criteria. 20 patients (Group A) had honey dressing and another 20 patients (Group B) had Povidone iodine dressing. We compared the wound healing status and bacteriological profile between day 1 and day 10 in both the groups. Result: The pain score decrement was significant in honey dressing group but the reduction in size of the wound was not significant. The bacteriological profile was more or less similar in both the groups. Conclusion: The antibacterial properties of honey, the cost effectiveness, easy availability, reduction in size of wound and more so the significant reduction in pain reveal that honey can be a safe, satisfying, cost effective topical dressing material for decubitus ulcers in general medical and surgical words. DOI: http://dx.doi.org/10.3126/ajms.v6i4.11616 Asian Journal of Medical Sciences Vol.6(4) 2015 99-101

The interaction of hearing loss and level-dependent hearing protection on speech recognition in noise

Objectives: To determine the effects of different control settings of level-dependent hearing protectors on speech recognition performance in interaction with hearing loss. Design: Controlled laboratory experiment with two level-dependent devices (Peltor® PowerCom Plus™ and Nacre QuietPro®) in two military noises. Study sample: Word recognition scores were collected in protected and unprotected conditions for 45 participants grouped into four hearing profile categories ranging from within normal limits to moderate-to-severe hearing loss. Results: When the level-dependent mode was switched off to simulate conventional hearing protection, there were large differences across hearing profile categories regarding the effects of wearing the devices on speech recognition in noise; participants with normal hearing showed little effect while participants in the most hearing-impaired category showed large decrements in scores compared to unprotected listening. Activating the level-dependent mode of the devices produced large speech recognition benefits over the passive mode at both low and high gain pass-through settings. The category of participants with the most impaired hearing benefitted the most from the level-dependent mode. Conclusions: The findings indicate that level-dependent hearing protection circuitry can provide substantial benefits in speech recognition performance in noise, compared to conventional passive protection, for individuals covering a wide range of hearing losses.

Health-Related Quality of Life (HRQL) and Health Utilities (HU) of Patients with Chronic Hepatitis C (CH-C) Treated with an Interferon (IFN)-Free Regimen Containing Ledipasvir (LDV) and Sofosbuvir (SOF)

Introduction: HRQL is an important patient-reported outcome while heath utilities measure patients’ preferences and are used for economic analyses. Aim: To assess HRQL and utilities for SOF plus LDVcontaining regimens. Methods: Short form 36 (SF-36) was administered at baseline, during, and post-treatment to HCV genotype 1 patients treated with SOF plus LDV with or without RBV (ION-1, 2, and 3 clinical trials). SF-6D scores were calculated from the SF-36 scores. Results: A total of 1,952 CH-C patients were included. Baseline SF-36 scores were similar across study arms (p>0.05). During treatment, RBV-containing regimens showed minimal decrements in 6 SF-36 scales (up to -5.4% for role physical, all p<0.03); while IFN- and RBV-free arms showed an improvement in all scales (up to +5.1% for vitality, all p<0.02). At the end of follow-up, patients with SVR-12 showed an improvement of the HRQL (up to +7.2% for vitality, all p<0.0001). Baseline SF-6D scores showed no differences between treatment arms (all p>0.05). During treatment with the RBV-containing regimens, decrements in SF6D scores were observed starting as early as week 4 of treatment (-2.0%, p=0.0005) and continued throughout treatment (-3.8% in the 8 weeks arm, -2.6% in 12 weeks, -3.3% in 24 weeks; all p<0.02). On the other hand, patients receiving RBV-free SOF plus LDV regimens showed improvement of their SF-6D scores during treatment (+3.5%, +4.8%, and +4.1% from baseline, respectively; all p<0.001). When compared directly to RBV-containing regimens, RBV-free SOF plus LDV regimen was associated with +5.2% (8 weeks), +5.9% (12 weeks), +5.9% (24 weeks) (all p<0.01) superiority in SF-6D during treatment. Receiving RBV was an independent predictor of on-treatment impairment in multivariate analysis (beta=-5.6±0.9%, p<0.0001). Nevertheless, regardless of the regimen, patients who achieved SVR-12 showed significant improvement of their SF-6D scores by week 12 post-treatment (+4.8%, p<0.0001), although post-SVR improvement in SF-6D in RBV-free arm was still superior: +5.6% vs. +3.9% (p=0.02). Subgroup analysis of patients with cirrhosis showed consistently lower scores (p=0.004 to <0.0001). Despite this, treatment-related and post-treatment changes in scores (decreases in RBV-containing vs. increases in RBV-free, as well as post-SVR increases in all regimens) were similar in cirrhotic and non-cirrhotic patients regardless of the treatment regimen (all p>0.05). Conclusion: RBV-free SOF plus LDV anti-HCV regimens are associated with significant improvement of HRQL and utilities during treatment. Although cirrhosis is associated with lower baseline scores, HCV cirrhotic patients treated with SOF plus LDV had treatment-related and post-treatment effect on HRQL/utilities similar to non-cirrhotics. Disclosure - Drs. Younossi, Afdahl, Kowdley, Marcellin are investigators for Gilead sciences and serve on their advisory board and/or consultants. This research was supported by an industry grant from Gilead Sciences.