Mean Follow-up Scores Research Articles

Outcome of cages in revision arthroplasty of the acetabulum: a systematic review.

Background and aim of the work: To investigate the clinical, radiological and functional outcomes of acetabular revisions with acetabular reinforcement rings and cages. Methods: A comprehensive literature study of international databases was performed. Inclusion criteria were cementless revisions, use of reinforcement rings, radiological and clinical follow-up, availability of full text in English, publication between January 1990 and July 2018. In a second further analysis, we selected only studies describing patients with more severe acetabular defects (AAOS 3, AAOS 4, Paprosky III). Data extracted included mean follow-up period, radiographic follow-up, functional scores, implant failures and survival rate. Results: We included in our review 1327 acetabular revisions described in 28 articles. The most commonly used reinforcement rings were Burch-Schneider ring, the Muller ring and the Ganz ring. Mean follow-up for all patients together was 8.8 years. Clinical or radiological signs of loosening were reported in 191 patients, 83 patients needed further acetabular revision for aseptic loosening and 41 patients received additional surgeries for septic loosening. The mean value of the Harris Hip Score reported at the last follow-up was 76.3. Nineteen articles fulfilled the criteria for further analysis about high-grade acetabular bone defects. We analyzed 649 revisions with mean follow-up period of 8.2 years. Clinical or radiological loosening was reported in 90 patients, additional acetabular revision was performed in 39 patients and 25 patients needed further surgeries for deep infection. Conclusion: Acetabular revisions with cages are characterized by good survival rates and functional scores with a mean follow-up period of 8 years. (www.actabiomedica.it)

Efficacy and Acceptability of Interventions for Attenuated Positive Psychotic Symptoms in Individuals at Clinical High Risk of Psychosis: A Network Meta-Analysis.

Background: Attenuated positive psychotic symptoms represent the defining features of the clinical high-risk for psychosis (CHR-P) criteria. The effectiveness of each available treatment for reducing attenuated positive psychotic symptoms remains undetermined. This network meta-analysis (NMA) investigates the consistency and magnitude of the effects of treatments on attenuated positive psychotic symptoms in CHR-P individuals, weighting the findings for acceptability.Methods: Web of Science (MEDLINE), PsycInfo, CENTRAL and unpublished/gray literature were searched up to July 18, 2017. Randomized controlled trials in CHR-P individuals, comparing at least two interventions and reporting on attenuated positive psychotic symptoms at follow-up were included, following PRISMA guidelines. The primary outcome (efficacy) was level of attenuated positive psychotic symptoms at 6 and 12 months; effect sizes reported as standardized mean difference (SMD) and 95% CIs in mean follow-up scores between two compared interventions. The secondary outcome was treatment acceptability [reported as odds ratio (OR)]. NMAs were conducted for both primary and secondary outcomes. Treatments were cluster-ranked by surface under the cumulative ranking curve values for efficacy and acceptability. Assessments of biases, assumptions, sensitivity analyses and complementary pairwise meta-analyses for the primary outcome were also conducted.Results: Overall, 1,707 patients from 14 studies (57% male, mean age = 20) were included, representing the largest evidence synthesis of the effect of preventive treatments on attenuated positive psychotic symptoms to date. In the NMA for efficacy, ziprasidone + Needs-Based Intervention (NBI) was found to be superior to NBI (SMD = −1.10, 95% CI −2.04 to −0.15), Cognitive Behavioral Therapy-French and Morrison protocol (CBT-F) + NBI (SMD = −1.03, 95% CI −2.05 to −0.01), and risperidone + CBT-F + NBI (SMD = −1.18, 95% CI −2.29 to −0.07) at 6 months. However, these findings did not survive sensitivity analyses. For acceptability, aripiprazole + NBI was significantly more acceptable than olanzapine + NBI (OR = 3.73; 95% CI 1.01 to 13.81) at 12 months only. No further significant NMA effects were observed at 6 or 12 months. The results were not affected by inconsistency or evident small-study effects, but only two studies had an overall low risk of bias.Conclusion: On the basis of the current literature, there is no robust evidence to favor any specific intervention for improving attenuated positive psychotic symptoms in CHR-P individuals.

Trihexyphenidyl for dystonia in cerebral palsy.

Cerebral palsy occurs in up to 2.1 of every 1000 live births and encompasses a range of motor problems and movement disorders. One commonly occurring movement disorder amongst those with cerebral palsy is dystonia: sustained or intermittent involuntary muscle spasms and contractions that cause twisting, repetitive movements and abnormal postures. The involuntary contractions are often very painful and distressing and cause significant limitations to activity and participation.Oral medications are often the first line of medical treatment for dystonia. Trihexyphenidyl is one such medication that clinicians often use to treat dystonia in people with cerebral palsy. To assess the effects of trihexyphenidyl in people with dystonic cerebral palsy, according to the World Health Organization's (WHO) International Classification of Functioning, Disability and Health (ICF) domains of impairment, activity and participation. We also assessed the type and incidence of adverse effects in people taking the drug. We searched CENTRAL, MEDLINE, Embase, eight other databases and two trials registers in May 2017, and we checked reference lists and citations to identify additional studies. We included randomised controlled trials comparing oral trihexyphenidyl versus placebo for dystonia in cerebral palsy. We included studies in children and adults of any age with dystonic cerebral palsy, either in isolation or with the associated movement disorders of spasticity, ataxia, chorea, athetosis and/or hypotonia. We included studies regardless of whether or not the study authors specified the method used to diagnose dystonia in their study population. Primary outcomes were change in dystonia and adverse effects. Secondary outcomes were: activity, including mobility and upper limb function; participation in activities of daily living; pain; and quality of life. We used standard methodological procedures expected by Cochrane. We identified one study, which was set in Australia, that met the inclusion criteria. This was a randomised, double-blind, placebo-controlled, cross-over trial in 16 children (10 boys and 6 girls) with predominant dystonic cerebral palsy and a mean age of 9 years (standard deviation 4.3 years, range 2 to 17 years). We considered the trial to be at low risk of selection, performance, detection, attrition, reporting and other sources of bias. We rated the GRADE quality of the evidence as low.We found no difference in mean follow-up scores for change in dystonia as measured by the Barry Albright Dystonia Scale (BADS), which assesses eight body regions for dystonia on a 5-point scale (0 = none to 4 = severe), resulting in a total score of 0 to 32. The BADS score was 2.67 points higher (95% confidence interval (CI) -2.55 to 7.90; low-quality evidence), that is, worse dystonia, in the treated group. Trihexyphenidyl may be associated with an increased risk of adverse effects (risk ratio 2.54, 95% CI 1.38 to 4.67; low-quality evidence).There was no difference in mean follow-up scores for upper limb function as measured by the Quality of Upper Extremity Skills Test, which has four domains that collectively assess 36 items (each scored 1 or 2) and produces a total score of 0 to 100. The score in the treated group was 4.62 points lower (95% CI -10.98 to 20.22; low-quality evidence), corresponding to worse function, than in the control group. We found low-quality evidence for improved participation (as represented by higher scores) in the treated group in activities of daily living, as measured by three tools: 18.86 points higher (95% CI 5.68 to 32.03) for the Goal Attainment Scale (up to five functional goals scored on 5-point scale (-2 = much less than expected to +2 = much more than expected)), 2.91 points higher (95% CI 1.01 to 4.82) for the satisfaction subscale of the Canadian Occupational Performance Measure (COPM; satisfaction with performance in up to five problem areas scored on a 10-point scale (1 = not satisfied at all to 10 = extremely satisfied)), and 2.24 points higher (95% CI 0.64 to 3.84) for performance subscale of the COPM (performance in up to five problem areas scored on a 10-point scale (1 = not able to do to; 10 = able to do extremely well)).The study did not report on pain or quality of life. At present, there is insufficient evidence regarding the effectiveness of trihexyphenidyl for people with cerebral palsy for the outcomes of: change in dystonia, adverse effects, increased upper limb function and improved participation in activities of daily living. The study did not measure pain or quality of life. There is a need for larger randomised, controlled, multicentre trials that also examine the effect on pain and quality of life in order to determine the effectiveness of trihexyphenidyl for people with cerebral palsy.

Effectiveness of Integrative Restoration (iRest) Yoga Nidra on Mindfulness, Sleep, and Pain in Health Care Workers.

This article examines the effectiveness of Integrative Restoration (iRest) Yoga Nidra meditation on mindfulness, sleep, and pain in health care workers. As health care workers provide emotional support to patients, it is not uncommon for workers to experience both physical and mental exhaustion. One holistic approach to support employees is mindfulness training. iRest Yoga Nidra is a complementary and integrative health therapy that increases mindfulness. A pre-/postinterveniton descriptive survey design was used. Before and after experiencing iRest meditation, participants completed a 51-item questionnaire consisting of demographics plus 3 validated instruments: the Five-Facet Mindfulness Questionnaire (FFMQ), the Epworth Sleepiness Scale (ESS), and Department of Defense/Veterans Administration (DoD/VA) Pain Supplemental Questions (PSQ). A total of 15 participants completed both questionnaires. Postintervention FFMQ scores were significantly higher than preintervention (z = -3.294, P = .001). The highest subscale scores were "acting with awareness" and "nonjudging of inner experience." There was a not a significant difference in the mean ESS scores at baseline and follow-up. However, there was a strong negative correlation between the mean ESS improvement score and the number of weeks attended (rs = -0.705, P = .003). There was a not a significant difference in the mean pain baseline and follow-up scores. This study showed significant improvement in mindfulness of health care workers following a guided 8-week iRest Yoga Nidra program. The results of this study may provide some insight into helping health care workers deal with the demands of their profession in a positive manner, thus leading to an improved workplace environment.

Abstract P3-12-02: Predictors of adherence to adjuvant endocrine therapy (ET) for early breast cancer (BC) in a prospective clinic-based cohort

Abstract Background: Adjuvant ET is associated with improved survival in women with hormone receptor-positive early BC. Nonetheless, more than a quarter of women are non-adherent or discontinue therapy early. We aimed to identify whether baseline characteristics and changes in weight and patient-reported outcomes (PRO) early during the course of ET are associated with medication adherence behavior (MAB) in a prospective cohort. Methods: We enrolled women initiating or switching adjuvant ET for stage 0-III BC in a prospective clinic-based cohort. Participants completed PRO questionnaires at baseline, and 3, 6, and 12 months (mo) after initiating ET. PRO questionnaires included FACT-ES, the NIH PROMIS measures for pain interference, fatigue, depression, anxiety, physical function, and sleep disturbance, and the MOS Sexual Functioning Scale. MAB was assessed by the Medication Adherence Questionnaire (MAQ). MAB was defined as high (MAQ score=0), or medium/low (MAQ score>0). Questionnaires were administered through the PatientViewpoint web-based interface. We tested changes in mean PRO scores from baseline to follow-up time points with paired t-tests. We explored associations between baseline characteristics, and changes in weight and PRO at 6 mo with MAB at 12 mo using Fisher's exact test, Wilcoxan rank sum tests and t-tests. P-values <0.05 were considered significant. Results: From March 2012 to December 2016, 336 women enrolled in the cohort. Mean age was 60 (range 26-90), 84% were Caucasian, and 67% were post-menopausal. Overall, 57% received an aromatase inhibitor, 43% received tamoxifen, and 28% received prior taxane chemotherapy. Median follow-up was 12 mo. At baseline, 61% were overweight/obese, and 21% gained >5% of baseline weight by 12 mo. Mean baseline and follow-up scores at 3, 6 and 12 mo were within 1 standard deviation of reference population means for all PRO measures. Compared to baseline, endocrine symptoms were increased at 3, 6 and 12 mo (p<0.05), while sexual function and depression did not differ between baseline and any follow-up time point (p>0.05). At 6 mo, anxiety was reduced, physical function was improved and pain impact was reduced compared to baseline (p<0.05). MAB was high for 71% of participants at 12 mo. Preliminary data demonstrate that, compared to those with high MAB at 12 mo, women with medium/low MAB at 12 mo took fewer concomitant medications at baseline, and had more improvement in anxiety and sexual function at 6 mo. MAB at 12 mo did not differ according to race, type of ET, baseline weight or PRO measures, or 6 mo change in weight or other PRO measures. Conclusions: Early changes in anxiety and sexual function during the course of adjuvant ET and the number of baseline concomitant medications may separate women with subsequent high versus medium/low MAB risk. Weight loss interventions and symptom management are needed for women receiving adjuvant ET during the first year of treatment. Our data will be used to create a model to predict MAB for validation studies and as the basis to devise interventions to improve adherence to adjuvant ET. Citation Format: Smith KL, Yeruva SLH, Blackford A, Huang C-Y, Westbrook KE, Harding BA, Smith A, Fetting J, Wolff AC, Jelovac D, Miller RS, Connolly R, Armstrong D, Nunes R, Visvanathan K, Stearns V. Predictors of adherence to adjuvant endocrine therapy (ET) for early breast cancer (BC) in a prospective clinic-based cohort [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-12-02.

Short-term outcomes of open hip preservation surgery for symptomatic extraarticular femoroacetabular impingement.

The purposes of this study were to describe: (i) short-term disease-specific patient-reported outcome scores (PROMs); and (ii) factors associated with reoperation or treatment failure in patients undergoing open hip preservation surgery for symptomatic extraarticular FAI. Patients undergoing open hip preservation surgery for symptomatic extraarticular FAI were identified from a prospective, single-centre hip preservation registry (n = 51 patients; median clinical follow-up 24 [range 11-49] months). Hip-specific PROMs were assessed preoperatively, 6 months, and each year subsequently. Patients undergoing reoperation or treatment failure (<10 point improvement in iHOT-33 postoperatively) over the study period were identified. Preoperative associated factors were explored on a univariate basis. International Hip Outcome Tool-33 (iHOT-33) improved from 33 (standard deviation [SD] 18) to 62 (26) at most recent follow-up and 76% of patients improved by minimum clinically important difference (MCID). Harris Hip Score improved from 53 (15) to 75 (17) at most recent follow-up and 79% of patients improved by MCID. Hip Outcome Score (HOS) Sport improved from 45 (26) to 66 (28) at most recent follow-up and 60% of patients improved by MCID. Continued improvements in mean follow-up scores were seen from 1 year to 2 years. Overall, 7 patients underwent reoperation and 9 patients failed to improve by MCID. Preoperative HOS Sport was higher in patients experiencing reoperation or treatment failure (58 [SD 19] vs. 40 [SD 27] respectively; p = 0.03). No other associated demographic, physical examination, or radiographic factors were found. Open treatment of extraarticular FAI results in short-term improvements in hip-specific PROMs in most patients. Higher HOS Sport scores were associated with reoperation or treatment failure. Longer-term follow-up is necessary to define maximum improvements in this challenging patient population.

Acceptance and commitment therapy universal prevention program for adolescents: a feasibility study

BackgroundThere is a need to prevent anxiety and depression in young people and mindfulness contains important emotion regulation strategies. Acceptance and commitment therapy (ACT), a mindfulness-based therapy, has yet to be evaluated as a prevention program, but has demonstrated an ability to reduce symptoms of anxiety and depression in adult and adolescent populations. This study examines the feasibility of using an ACT-based prevention program in a sample of year 10 (aged 14–16 years) high school students from Sydney, Australia.MethodsParticipants were allocated to either their usual classes or to the ACT-based intervention. Participants were followed for a period of 5 months post-intervention and completed the Flourishing Scale, Depression Anxiety Stress Scale, and a program evaluation questionnaire. Analyses were completed using intention-to-treat mixed models for repeated measures.ResultsThe results indicated that the intervention was acceptable to students and feasible to administer in a school setting. There were no statistically significant differences between the conditions, likely due to the small sample size (N = 48). However, between-group effect sizes demonstrated small to large differences for baseline to post-intervention mean scores and medium to large differences for baseline to follow-up mean scores, all favouring the ACT-based condition.ConclusionThe results suggest that an ACT-based school program has potential as a universal prevention program and merits further investigation in a larger trial.Trial registration Australian New Zealand Clinical Trials Registry. Trial ID: ACTRN12616001383459. Registered 06/10/2016. Retrospectively registered.

Epigenetic Effects of PTSD Remediation in Veterans Using Clinical Emotional Freedom Techniques: A Randomized Controlled Pilot Study.

To assess the feasibility of measuring changes in gene expression associated with post-traumatic stress disorder (PTSD) treatment using emotional freedom techniques (EFT). Participants were randomized into an EFT group receiving EFT and treatment as usual (TAU) throughout a 10-week intervention period and a group receiving only TAU during the intervention period and then receiving EFT. A community clinic and a research institute in California. Sixteen veterans with clinical levels of PTSD symptoms. Ten hour-long sessions of EFT. Messenger RNA levels for a focused panel of 93 genes related to PTSD. The Symptom Assessment 45 questionnaire, Hospital Anxiety and Depression Scale, Insomnia Severity Scale, SF-12v2 for physical impairments, and Rivermead Postconcussion Symptoms Questionnaire. Pre-, posttreatment, and follow-up mean scores on questionnaires were assessed using repeated measures 1-way analysis of variance. A Student t test and post hoc analyses were performed on gene expression data. Post-traumatic stress disorder symptoms declined significantly in the EFT group (-53%, P < .0001). Participants maintained their gains on follow-up. Significant differential expression of 6 genes was found ( P < .05) when comparing the expression levels before and after the intervention period in participants receiving EFT. Study results identify candidate gene expression correlates of successful PTSD treatment, providing guidelines for the design of further studies aimed at exploring the epigenetic effects of EFT.

Neurobehavioral Outcomes After Cardiac Arrest

Research Article| June 01 2016 Neurobehavioral Outcomes After Cardiac Arrest AAP Grand Rounds (2016) 35 (6): 65. https://doi.org/10.1542/gr.35-6-65 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Neurobehavioral Outcomes After Cardiac Arrest. AAP Grand Rounds June 2016; 35 (6): 65. https://doi.org/10.1542/gr.35-6-65 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: cardiac arrest, out-of-hospital cardiac arrest Slomine BS, Silverstein FS, Christensen JR, et al. Neurobehavioral outcomes in children after out-of-hospital cardiac arrest. Pediatrics. 2016; 137(4): e20153412; doi: https://doi.org/10.1542/peds.2015-3412Google Scholar Investigators from multiple institutions sought to determine the neurobehavioral outcomes 12 months following out-of-hospital cardiac arrest (OH-CA) among children who were comatose following resuscitation. Participants in the current study consisted of a subgroup of children who had been enrolled in a clinical trial, Therapeutic Hypothermia After Pediatric Cardiac Arrest, Out-Of-Hospital (THAPCA-OH), to determine whether targeted temperature management to hypothermia (33.0°C) was more beneficial than targeting to normothermia (36.8°C). Neurobehavioral function was assessed by caregiver responses on the Vineland Adaptive Behavior Scales-Second Edition (VABS-II). The VABS-II measures functional skills and provides age-corrected standard scores. A baseline score, based on functioning before OH-CA, was obtained from caregivers within 24 hours of enrollment and compared to scores obtained 12 months after the event. Only participants with normal (>70) baseline composite VABS-II scores were eligible for this study. The primary outcome was change in VABS-II scores from baseline to follow-up in each study child; statistical significance of the change was assessed with paired t-tests. Regression models were used to identify independent associations with change in composite VABS-II scores. Of the 295 children, aged 2 days to 18 years, enrolled in the THAPCA-OH study, 96 were alive at 12 months post-arrest. Among these 96 survivors, 87 had normal baseline composite VABS-II scores and were eligible for the current study. Follow-up was completed in 85 of the 87. VABS-II composite, domain, and subdomain scores in study participants declined significantly between baseline and the 12-month follow-up (P < .001 for all comparisons). Mean baseline scores ranged from 95–106; mean follow-up scores ranged from 68–81. The mean change in composite VABS-II score was −21 for children <3 years of age, −28 for children 3–6 years of age and −46 for children ≥6 years of age. At 12-month follow-up, 49% (42/85) of the children had normal VABS-II scores (≥70) and 38% (32/85) had composite scores within 15 points of their baseline. Most children also demonstrated below average cognitive functioning at the 12-month followup. Treatment with hypothermia did not influence neurobehavioral outcomes. In the multivariate analysis, older age at the time of arrest and higher baseline VABS-II score were independent predictors of decline in composite VABS-II scores following OH-CA. The investigators conclude that significant neurobehavioral deficits persist in children surviving OH-CA who were comatose after resuscitation. Younger age at the time of arrest was associated with better neurobehavioral outcome. Dr Anderson has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Pediatric OH-CA is a rare event occurring in ~8/100,000 person-years (compared to 126/100,000 person-years in the adult population).1 Children who experience in-hospital cardiac arrest undergo more rapid resuscitation and presumably have less incremental brain injury.2 The results of the current study not only highlight the poor survival... You do not currently have access to this content.

Sacral nerve stimulation for faecal incontinence: medium-term follow-up from a single institution.

Most studies on sacral nerve stimulation (SNS) are either single-centre with small numbers of patients or multi-centre studies. We present the medium-term follow-up results from a single centre for 127 patients undergoing SNS. Consecutive patients treated with SNS for faecal incontinence had preoperative baseline St Mark's continence scores, faecal incontinence quality of life (FIQL) measures and anorectal physiology studies. Follow-up was a postal questionnaire concerning continence, FIQL, patient-perceived change in bowel control (-5 to +5 where 0 is no change), overall satisfaction (0-10 visual analogue scale) and use of medications. A total of 166 patients underwent temporary nerve stimulation testing, of which 112 progressed to a permanent implantable pulse generator (IPG). Fifteen received an IPG without the testing phase, hence 127 patients in total. Fourteen had the IPG removed, four were deceased, leaving 109 for assessment; 91 (83%) responded to the survey. Mean follow-up was 2.7 years (range: 2 months-8.5 years). Mean baseline St Mark's continence score was 14.4, and mean follow-up score was 10.3 (P < 0.01). FIQL improved in all domains (P < 0.001). Patient-reported improved bowel control mean score was +3.2 (95% CI: 2.9, 3.55). Median satisfaction score was 8.0 (range: 0-10). Complications included 17 lead dislodgements, seven superficial infections, five infections requiring surgery and five repositioning of a rotated IPG. Thirty-two patients used loperamide and 34 used fibre supplements. In this observational study, limited by the absence of a placebo control group, SNS significantly improved continence and quality of life, and patient satisfaction was high.

Impact of a psychiatry clerkship on stigma, attitudes towards psychiatry, and psychiatry as a career choice.

BackgroundMental illnesses are a major public health problem around the world and the prevalence and burden of common mental disorders is growing. Psychiatry is an unpopular career choice for many medical students and this impacts negatively on the supply of psychiatrists to the workforce. The psychiatry clerkship can play an important role in influencing students’ attitudes towards psychiatry, either positively or negatively. However, stigma towards mental illness detracts students from considering a career in psychiatry. The aim of this study was to assess the impact of an eight week psychiatry clerkship on i) student knowledge and interest in psychiatry; ii) psychiatry as a career choice; iii) attitudes towards psychiatry; and iv) perceptions of stigma towards mental illness.MethodYear 4 medical students at the University of Western Australia completed two questionnaires, the Balon Attitudes Towards Psychiatry and the Mental Illness Clinicians Attitudes (MICA), at the beginning and end of the psychiatry clerkship. Interest in, knowledge of, and consideration of psychiatry as a career were also assessed. Non-parametric tests were used to compare baseline and follow-up differences on the Balon and MICA. Unpaired t-tests compared mean differences for interest, knowledge and psychiatry as a career.ResultsAttitudes towards psychiatry were positive at the beginning of the clerkship. Overall, there was a significant decrease in negative and stigmatising views towards mental illness post clerkship measured by the MICA, but the follow-up mean score remained close to the neutral value with views in some areas becoming more negative. There was no significant improvement in students’ interest in psychiatry post clerkship, however, knowledge of psychiatry improved significantly. Numbers of students ‘definitely considering’ psychiatry as a career increased significantly from 7 (4.6%) students at baseline to 17 (10.5%) at follow-up.ConclusionThe clerkship made a modest impact on students’ attitudes to psychiatry, stigma and consideration of psychiatry as a career. Integration of strategies to overcome stigma towards mental illness and the mental health profession into pre-clinical teaching may provide students with skills to prepare them for the clerkship. This may assist in improving attitudes towards psychiatry and encourage more students towards a psychiatry career.

Transurethral resection of fibrotic scar tissue combined with temporary urethral stent placement for patients with in anterior urethral stricture.

Fibrotic scar formation is a main cause of recurrent urethral stricture after initial management with direct vision internal urethrotomy (DVIU). In the present study, we devised a new technique of combined the transurethral resection of fibrotic scar tissue and temporary urethral stenting, using a thermo-expandable urethral stent (Memokath(TM) 044TW) in patients with anterior urethral stricture. As a first step, multiple incisions were made around stricture site with cold-utting knife and Collins knife electrode to release a stricture band. Fibrotic tissue was then resected with a 13Fr pediatric resectoscope before deployment of a MemokathTM 044TW stent (40 - 60mm) on a pre-mounted sheath using 0° cystoscopy. Stents were removed within12 months after initial placement. We performed this technique on 11 consecutive patients with initial (n = 4) and recurrent (n = 7) anterior urethral stricture (April 2009 – February 2013). At 18.9 months of mean follow-up (12-34 months), mean Qmax (7.8±3.9ml/sec vs 16.8 ± 4.8ml/sec, p < 0.001), IPSS (20.7 vs 12.5, p = 0.001 ), and QoL score (4.7 vs 2.2, p < 0.001) were significantly improved. There were no significant procedure-related complications except two cases of tissue ingrowth at the edge of stent, which were amenable by transurethral resection. In 7 patients, an average 1.4 times (1-5 times) of palliative urethral dilatation was carried out and no patients underwent open surgical urethroplasty during the follow-up period. Combined transurethral resection and temporary urethral stenting is a effective therapeutic option for anterior urethral stricture. Further investigations to determine the long-term effects, and safety profile of this new technique are warranted.

Impacts of Child Development Accounts on maternal depressive symptoms: Evidence from a randomized statewide policy experiment

This study examines the impact of Child Development Accounts (CDAs)—asset-building accounts created for children at birth—on the depressive symptoms of mothers in a statewide randomized experiment conducted in the United States. The experiment identified the primary caregivers of children born in Oklahoma during 2007, and 2704 of the caregivers completed a baseline interview before random assignment to the treatment (n = 1358) or the control group (n = 1346). To treatment participants, the experiment offered CDAs built on the existing Oklahoma 529 College Savings Plan. The baseline and follow-up surveys measured the participants' depressive symptoms with a shortened version of the Center for Epidemiologic Studies Depression Scale (CES-D). In models that control for baseline CES-D scores, the mean follow-up score of treatment mothers is .17 lower than that of control mothers (p < .05). Findings suggest that CDAs have a greater impact among subsamples that reported lower income or lower education. Although designed as an economic intervention for children, CDAs may improve parents' psychological well-being. Findings also suggest that CDAs' impacts on maternal depressive symptoms may be partially mediated through children's social–emotional development.

An anti-inflammatory diet as treatment for inflammatory bowel disease: a case series report

BackgroundThe Anti-Inflammatory Diet (IBD-AID) is a nutritional regimen for inflammatory bowel disease (IBD) that restricts the intake of certain carbohydrates, includes the ingestion of pre- and probiotic foods, and modifies dietary fatty acids to demonstrate the potential of an adjunct dietary therapy for the treatment of IBD.MethodsForty patients with IBD were consecutively offered the IBD-AID to help treat their disease, and were retrospectively reviewed. Medical records of 11 of those patients underwent further review to determine changes in the Harvey Bradshaw Index (HBI) or Modified Truelove and Witts Severity Index (MTLWSI), before and after the diet.ResultsOf the 40 patients with IBD, 13 patients chose not to attempt the diet (33%). Twenty-four patients had either a good or very good response after reaching compliance (60%), and 3 patients’ results were mixed (7%). Of those 11 adult patients who underwent further medical record review, 8 with CD, and 3 with UC, the age range was 19–70 years, and they followed the diet for 4 or more weeks. After following the IBD-AID, all (100%) patients were able to discontinue at least one of their prior IBD medications, and all patients had symptom reduction including bowel frequency. The mean baseline HBI was 11 (range 1–20), and the mean follow-up score was 1.5 (range 0–3). The mean baseline MTLWSI was 7 (range 6–8), and the mean follow-up score was 0. The average decrease in the HBI was 9.5 and the average decrease in the MTLWSI was 7.ConclusionThis case series indicates potential for the IBD-AID as an adjunct dietary therapy for the treatment of IBD. A randomized clinical trial is warranted.

Emergency Contraception Counseling in a Retail Pharmacy Setting

Introduction: Nonprescription emergency contraception (EC) is now available for purchase without age restrictions. This is a great opportunity for pharmacists to provide counseling to ensure that customers use EC correctly. Objective: This pilot study explored the impact of student pharmacist counseling on customer knowledge of EC in a retail pharmacy setting and assessed customer satisfaction with the counseling. Methods: Counseling was performed at 2 retail pharmacies during June and July 2012. Participants completed a 12-question pretest that measured baseline knowledge of EC prior to a 5- to 10-minute education session, followed by the same 12-question posttest. A follow-up test was conducted via telephone within 1 to 3 months after the counseling. Results: Eighty-seven women participated with a mean age of 30.2 (standard deviation = 7.2) years. The average posttest score was significantly higher than the pretest score (11.5 ± 1.0 vs 8.5 ± 2.5; P < .001). The mean follow-up score (9.9 ± 1.1) was significantly higher than the pretest score (P = .014), which indicated retained knowledge. Participants reported being highly satisfied with the counseling session and strongly agreed that the counseling would help them use EC correctly. Conclusion: Student pharmacist-provided EC counseling increased participants’ EC knowledge both immediate and long term. This study suggests that EC counseling is feasible and valued by customers.

Cleaning ability of toothbrush with or without the use of dentifrice on debris and plaque removal in hostel inmates aged 20-24 years

Objectives: The aim was to find the cleaning ability of the toothbrush with or without the use of dentifrice in removal of debris and plaque in hostel inmates aged 20-24 years. Materials and Methods: A randomized clinical trial was carried out on 30 undergraduate students of K.D. Dental College and Hospital. The debris and plaque scores were recorded using debris index-simplified and plaque index respectively. The subjects were divided into three groups. After recording the baseline scores, the study groups were instructed to follow the modified bass method for the period of 10 days and then follow-up scores were recorded. Paired ' t '- test and one-way ANOVA test was used to compare the mean baseline and mean follow-up scores. Results: The difference in mean debris scores at baseline and follow-up for Group II ( P = 0.000) and Group III ( P = 0.005) was found to be statistically significant. However, for Group I ( P = 0.153), this difference was not significant. The difference in mean plaque scores at baseline and follow-up in all the three groups was statistically significant. When the mean differences in debris and plaque scores of the three groups were compared, it was found to be statistically significant for Group I and Group II and Group I and Group III, however, it was not significant for Groups II and III. Conclusion: The present study showed that the cleaning ability of the toothbrush with dentifrice was more effective in the removal of debris and plaque than the cleaning ability of the toothbrush without dentifrice.

Responsiveness of the MOS-HIV and EQ-5D in HIV-infected adults receiving antiretroviral therapies

BackgroundSelection of an appropriate patient-reported outcome (PRO) instrument for a clinical trial requires knowledge of the instrument’s responsiveness to detecting treatment effects. The purpose of this study was to examine the responsiveness of two health-related quality of life (HRQL) instruments used in clinical trials involving HIV-infected adults: the HIV-targeted Medical Outcomes Study HIV Health Survey (MOS-HIV), and a generic measure, the EuroQol-5D (EQ-5D).MethodsA systematic review identified clinical trials using the MOS-HIV or EQ-5D to assess outcomes for HIV-infected adults. Data abstracted from each study included study type, treatment regimen(s), PRO results, and effect size (either reported or calculated). Effect size was calculated as the difference between baseline and follow-up mean scores divided by the baseline standard deviation. Magnitude was categorized as small (d=0.20), medium (d=0.50), and large (d=0.80).ResultsBetween 2005 and 2010, the MOS-HIV was administered in 12 trials. Significant differences were observed between groups and over time in physical health summary (PHS) and mental health summary (MHS) scores (P<0.05) in subjects switching therapy after experiencing Grade-2 adverse events. Effect sizes were medium (0.55 and 0.49 for PHS and MHS, respectively) among treatment-naïve adults beginning therapy (two studies), but negligible among treatment-experienced adults (0.04 and 0.13 for PHS and MHS, respectively; three studies). The EQ-5D was used in five trials between 2001 and 2010. It was responsive to occurrences of adverse events and opportunistic infections, with small-to-medium effect sizes (range 0.30–0.50) in each of its five dimensions.ConclusionsA systematic review of PRO study results showed both the MOS-HIV and EQ-5D were responsive to changes between groups and/or over time in treatment-naïve HIV-infected patients. These instruments may be used either individually or together in clinical trials to measure changes in HRQL.

Minimal clinically important differences in the brief pain inventory in patients with bone metastases

The brief pain inventory (BPI) is often used to assess pain and functional interference as a result of pain in cancer patients. Minor improvements or deteriorations in BPI may be statistically significant due to large sample sizes but may not necessarily be clinically relevant. The purpose of this study was to determine the minimal clinically important differences (MCID) in the functional BPI in patients with pain due to bone metastases. BPI scores were collected from patients with painful bone metastases who visited the Rapid Response Radiotherapy Program for palliative radiotherapy. Pain and functional interferences scores were also collected monthly for three months. Patients were categorized into "complete or partial response," "pain progression," and "indeterminate response" based on their pain scores as recommended by the latest consensus definitions. Anchor-based determination of MCIDs of functional interference scores was calculated by determining the difference between the mean follow-up scores and the mean baseline scores for patients from each of the three response groups. Distribution-based estimates were obtained utilizing 0.2, 0.3, and 0.5 standard deviation (SD) effect sizes and the standard error of measurement. The anchor-based method results were compared with the distribution-based method results. Statistically significant MCIDs were determined for all of the functional interference items of BPI for patients with "complete or partial response"; whereas, no statistically significant MCIDs in BPI scores could be determined for patients with "pain progression." Some of the functional interference items of BPI had statistically significant MCIDs for patients with "indeterminate response," although these were generally smaller than patients with complete or partial response. Using the distribution-based approach, an effect size of 0.5 SD was the closest estimate for determining the MCID for both patients with complete or partial response and those with indeterminate response. The MCIDs determined for pain improvement were rather large, where as statistically significant MCIDs could not be detected for pain deterioration. Knowledge of MCIDs utilizing the BPI will allow physicians to evaluate the impact of treatment (or no treatment) on a patient's functional abilities. Knowledge of MCIDs may allow for sample size determination in future clinical trials.

An Application of a Diabetes Knowledge Scale for Low-Literate Hispanic/Latinos

The threefold purpose of this study is to assess diabetes knowledge among Hispanic/Latinos attending a culturally sensitive, empowerment-based, diabetes self-management education program; second, to examine the utility of the Spoken Knowledge in Low Literacy in Diabetes (SKILLD) scale as an assessment tool for this population; and third, to assess the relationship between hemoglobin A1C and knowledge improvement in the intervention group. A prospective, quasi-experimental, repeated-measure design tested pre- and post-A1C and diabetes knowledge using the SKILLD scale. The sample consisted of 71 in the intervention group and 64 controls. Most participants were female, marginally acculturated, and, on average, 60 years of age. Both groups were similar in baseline diabetes knowledge score (median 6 out of 10), and higher literacy was significantly related to increased baseline knowledge. The intervention group significantly improved at follow-up compared with the controls: Participants in the intervention with low baseline knowledge scores had a mean follow-up score of 5.6; those with a high baseline score had a mean score of 7.6. The intervention cohort scored significantly better in knowing why to see an eye doctor, what are normal fasting blood glucose and A1C, and understanding long-term diabetes complications. Increased knowledge of a normal fasting blood glucose level had a significant effect on follow-up A1C in the intervention group. The intervention favorably affects diabetes knowledge, and the SKILLD scale has utility with low-literate Hispanic/Latinos. The significant impact on A1C by diabetes knowledge gain shows that the empowerment-based diabetes self-management education was successful for this ethnic population.

Responsiveness and minimally important difference of a generic quality of life measure for complementary health practices

Shorter and easier methods of conducting community health surveys would be useful. We conducted a study to demonstrate the responsiveness of the 10-item Mokichi Okada Association quality of life questionnaire (MQL-10) in a follow-up survey and to determine the minimally important difference (MID) for this measure. In 2007, Japanese adults participated in a survey on health prac- tices. We analyzed the MQL-10 scores (n=6365) together with the following factors: gender, age group, disease, reason for participation, and complementary health practices, such as food and eating. The mean baseline MQL-10 score was 26.4±5.83 [standard deviation (SD)] and the mean follow-up score was 27.6±5.45 SD with a mean change of 1.20±4.41 SD. The effect size for change was 0.21 and the standardized response mean was 0.27. The MQL-10 scores in the baseline condition were associated with gender, age group, disease, reason for participation and complementary health practices. Furthermore, the changes in the MQL-10 during the 12 weeks of study were associated with age group, disease, reason for participa- tion and complementary health practices. The increase in frequency of health practices was significantly associated with improvements in the participants’ quality of life (QOL). These results suggest that the MQL-10 is use- ful for assessing the effects of complementary health practices on QOL. The estimate of 3 points for the range of this measure (0-40) was higher than half of the SD of scores; therefore, it was considered reasonable for the MID.