Total Patient Sample Research Articles

Increased serum levels of sortilin-derived propeptide after electroconvulsive therapy in treatment-resistant depressed patients.

PurposeSortilin-derived propeptide (PE) and its synthetic analog spadin show strong antidepressant activity in rodents and, therefore, could be used as a biomarker to evaluate the clinical efficacy of antidepressant treatments. The aim of this study was to determine whether electroconvulsive therapy (ECT) modulates serum PE concentration in patients with treatment-resistant depression (TRD).Patients and methodsForty-five patients with major depressive disorder, who met the Diagnostic and Statistical Manual of Mental Disorders-IV criteria, were selected for this study.ResultsWe did not observe any difference in the PE levels between TRD patients and controls (z=0.10, P=0.92), but we found a strong significant increase between the PE levels measured just before (T0) and about 1 month (T2) after ECT (z=−2.82, P=0.005). A significant difference between T0 and T2 was observed only in responders (z=−2.59, P=0.01), whereas no effect was found in nonresponders (z=−1.27, P=0.20). Interestingly, we found a significant correlation between the increase in PE levels and decrease in Montgomery -Åsberg Depression Rating Scale scores for the total patient sample (P=0.03).ConclusionThis study indicates for the first time that ECT affects serum PE concentration in responders and, therefore, could contribute to the evaluation of the therapy success.

Efficacy of a platelet-rich plasma injection for the treatment of proximal hamstring tendinopathy: A pilot study

ObjectivesTo determine the efficacy of an ultrasound-guided platelet-rich plasma (PRP) injection in the treatment of patients with proximal hamstring tendinopathy (PHT). DesignPilot prospective cohort study MethodsAdministration of a single PRP injection under ultrasound guidance to 29 patients with PHT confirmed on magnetic resonance imaging (MRI). Pain, function and sporting activity were measured via the Victorian Institute of Sport Assessment-Proximal Hamstring Tendons (VISA-H) questionnaire, administered before injection and at 8-weeks follow-up. ResultsThe study sample consisted of 22 females and 7 males with a mean age of 45.2 years (95% CI 40.8–49.5). When comparing pre-injection VISA-H scores (mean: 43.90; 95% CI 37.77–50.03) with 8-week post-injection VISA-H scores (mean: 51.14; 95% CI 43.39–58.88) in the total sample of patients, no statistically significant difference was found (p=0.14). When performing separate analyses for patients with mild (n=9), moderate (n=16) or marked (n=4) PHT, no statistically significant difference was found in pre-and post-injection VISA-H scores for any of the groups (p=0.86, p=0.13, p=0.28 respectively). 69% of patients reported no change in their ability to undertake sport or other physical activity at 8-weeks follow-up. ConclusionsPatients with PHT receiving a PRP injection did not improve on clinical outcomes at 8-weeks follow-up.

Sesamoid complex angle correction after arthrodesis of the first cuneometatarsal joint in the treatment of hallux valgus

Objective: To evaluate the degree of sesamoid complex correction in patients with moderate and severe hallux valgus undergoing cuneometatarsal arthrodesis by comparing general pre- and postoperative values and also post-reduction outcomes between moderate and severe cases. Methods: The radiographs of 24 patients (83.3% females and 16.7% males) who underwent arthrodesis of the first cuneometatarsal joint wereretrospectively analysed. The patients’ mean age was 52.58 years. The metatarsophalangeal, intermetatarsal and sesamoid dislocation angles were measured on the preoperative and immediate postoperative radiographs, with the former measured in the standing position and the latter measured intraoperatively, all in the anteroposterior incidence. The first metatarsal lateralization necessary to centralize the sesamoids wasmeasured in degrees. We refer to this angle as the “angle to be corrected”. Results: We achieved sesamoid dislocation correction, reducing the indicated angles in relation to their preoperative values. Both moderate and severe cases showed statistically significant differences in angular correction after surgery, with p=0.018 and p<0.001, respectively. Comparing the moderate and severe cases, a statistically significant difference was observed preoperatively, with p=0.007; however, the results were not statistically significant postoperatively (p=0.227). Conclusion: We achieved effective correction of the ABC in terms of both the total patient sample and the isolated analysis of the moderate and severe groups. Preoperatively, the moderate cases had smaller angles than the severe cases, but both groups exhibited reductions in these angles in the postoperative period and had similar outcomes.
 Level of Evidence III; Retrospective Study.

Uptake and usage of an online prostate cancer treatment decision aid in Dutch clinical practice: A quantitative analysis from the Prostate Cancer Patient Centered Care trial.

Implementation of patient's decision aids in routine clinical care is generally low. This study evaluated uptake and usage of a novel Dutch web-based prostate cancer treatment decision aid within the Prostate Cancer Patient Centered Care trial. From an estimated total patient sample of 1006 patients, 351 received a decision aid (35% implementation rate; hospital ranges 16%-84%). After receipt of the decision aid, most patients accessed the decision aid, utilized most functions, although not completely, and discussed the decision aid summary in a subsequent consultation with their care provider. Including nurses for dissemination of decision aids seemed to positively affect decision aid uptake. Once received, patients seemed able to use the decision aid and engage in shared decision-making as intended; however, decision aid uptake and complete usage of all decision aid components should be further improved. Prior to the diagnosis consultation, handing out of the decision aid should be prepared.

A cross-sectional study of experienced coercion in adolescent mental health inpatients

BackgroundInvoluntary care and coercive measures are frequently present in mental healthcare for adolescents. The purpose of this study was to examine to what extent adolescents perceive or experience coercion during inpatient mental health care, and to examine predictors of experienced coercion.MethodsA cross-sectional sample of 96 adolescent inpatients from 10 Norwegian acute and combined (acute and sub-acute) psychiatric wards reported their experienced coercion on Coercion Ladder and the Experienced Coercion Scale in questionnaires. Staff reported use of formal coercion, diagnoses, and psychosocial functioning. We used two tailed t-tests and mixed effects models to analyze the impact from demographics, alliance with parents, use of formal coercion, diagnostic condition, and global psychosocial functioning.ResultsHigh experienced coercion was reported by a third of all patients. In a mixed effects model, being under formal coercion (involuntary admission and / or coercive measures); a worse relationship between patient and parent; and lower psychosocial functioning, significantly predicted higher experienced coercion. Twenty-eight percent of the total sample of patients reported a lack of confidence and trust both in parents and staff.ConclusionsRoughly one third of patients in the sample reported high experienced coercion. Being under formal coercion was the strongest predictor. The average scores of experienced coercion in subgroups are comparable with adult scores in similar care situations. There was one exception: Adolescents with psychosis reported low experienced coercion and almost all of them were under voluntary care.

Proportion and characteristics of patients who were offered, enrolled in and completed audiologist-delivered cognitive behavioural therapy for tinnitus and hyperacusis rehabilitation in a specialist UK clinic

Objective: The aim was to determine the proportion and characteristics of patients who were offered, enrolled in and completed an audiologist-delivered cognitive behavioural therapy (CBT) programme for tinnitus and/or hyperacusis in a specialist Audiology Department in the National Health Service, UK. Design: This was a retrospective study. Study sample: Data were gathered for 266 consecutive patients with an average age of 56 y (standard deviation =15 y). Results: Following an initial assessment session, 68% of patients were judged to have problems sufficient for them to be offered audiologist-delivered CBT. The remaining 32% were discharged. Of those enrolled for CBT, 31% were discharged after the first CBT session, because they were judged to have insufficient tinnitus and/or hyperacusis distress. Of those offered continuing CBT, 45% declined to continue. Patients who continued were younger, had worse insomnia and had better hearing in their better ear than patients who declined. Of those who continued, 68% completed the six sessions of CBT. Conclusion: Although CBT is resource intensive, only 17% of the total patient sample received the full course of six sessions of CBT. Patients who accepted continuing CBT were younger, had worse insomnia and had better hearing than those who declined.

Do general practitioners record alcohol abuse in the electronic medical records? A comparison of survey and medical record data

Objective: Primary care professionals are encouraged to screen patients for alcohol abuse. However, patients with alcohol abuse are often under-diagnosed as well as under-registered in medical records in general practices. This study aims to report on the registration rates of alcohol abuse diagnoses in general practices in comparison to patients’ self-reported rates of alcohol use disorder.Research design and methods: Data of a total number of 2,349 patients were analyzed from the SMILE study, a large prospective cohort study conducted in The Netherlands. Two data collection strategies were combined: (1) Patient self-report data on alcohol consumption as well as other sociodemographic characteristics; (2) Medical record (ICPC codes) data of diagnoses of chronic and acute alcohol abuse of the same patients. GPs’ registrations of diagnoses were compared with the self-report data using descriptive statistics.Results: Based on the results of the patient reported data, 179 (14.8%) male participants had an alcohol use disorder. Of the total number of female patients, 82 (7.2%) had an alcohol use disorder. One of the male and none of the female patients with an alcohol use disorder were registered as such by the GP.Conclusions: This study found that 11.1% of the total patient sample reported an alcohol use disorder, of which a strikingly low number of patients were recorded as such by their GP. It is likely that low recognition due to barriers related to alcohol screening as well as registration avoidance due to the stigma around alcohol abuse play a role in low registration.

P 39 The genetic characteristics of epileptic encephalopathy in children

Relevance Disclosure of genetic aspects of epilepsy is necessary for a clear understanding of the etiology and pathogenesis of this disease, the search for new ways of correction. Objective to study the molecular and genetic aspects of epileptic encephalopathy and symptomatic epilepsy in children. Materials and methods We have analyzed 30 indicators of gene polymorphism SCN1A among 20 studied children with epileptic encephalopathy and 20 healthy children. Results Of the total sample of patients with epileptic encephalopathy in children (n = 20) polymorphism 3184 A-G met in the homozygous state (3184 ∗ A/ ∗ A) in 8 patients (40%) in the heterozygous state (3184 ∗ A/ ∗ G) - 11 (56%) and homozygous genotype (3184 ∗ G/ ∗ G) was identified in only 1 patient (4%). In healthy children (n = 20) polymorphism 3184 A-G met in the homozygous state (3184 ∗ A/ A) in 6 patients (60%) in the heterozygous state (3184 ∗ A/ ∗ G) - in 4 (40%). Conclusion Thus, considering all of the above it can be concluded mutations and polymorphisms in the gene SCN1A neuronal sodium channel leads to an increase in recovery time channel activity after inactivation and, as a consequence, provoke neuronal hyper excitability. We observed changes in the nucleotide sequence of the gene SCN1A that can make some contribution to the development of susceptibility to epileptic encephalopathy in children Uzbek nationality.

Effect of medical and nursing teaching program on awareness and adherence among elderly patients with chronic heart failure in Assiut, Egypt

IntroductionHeart failure (HF) among geriatric population is an eminent problem, and patient awareness of the disease and subsequent adherence to the treatment may decrease the burden of this serious problem.ObjectiveThe purpose of the study is to evaluate the effectiveness of medical as well as nursing teaching program on awareness and adherence among elderly patients with chronic HF.Patients and methodsThe study was carried out in the Internal Medicine Department of Assiut University Hospital. Total coverage sample of elderly patients included 100 patients from both sexes, and their age ranged from 60 to 75 year. The study was carried out in the Internal Medicine Department of Assiut University Hospital. Overall, three tools were used in this study: (a) patient interviewing sheet (pretest and post-test) tool consisting of two parts regarding demographic characteristic and medical data, (b) Atlanta HF knowledge test, and (c) adherence questionnaire.ResultsThe main results yielded by the study proved a highly statistically significant difference between pretest and post-test regarding awareness and adherence for patients.Conclusion and recommendationsThis study concluded that the medical and nursing teaching program was effective for awareness and adherence of the patients. More follow-up studies are needed to improve awareness and adherence for older adult patients with chronic HF to prevent complications.

Factores asociados con cardiopatía isquémica en pacientes diabéticos con diagnóstico de aterosclerosis subclínica. Seguimiento a cuatro años

OBJECTIVE: To describe and analyze the factors associated with the development of ischemic heart disease in patients previously diagnosed with subclinical atherosclerosis in follow-up to four years. MATERIAL AND METHODS: An observational, descriptive and retrospective study including 52 diabetic patients diagnosed with subclinical atherosclerosis followed to four years, describing the factors associated with the development of ischemic heart disease was designed. Patients who left the track were excluded, lost or died. mean, standard deviation, frequencies and percentages with a CI 95% were determined. discriminant analysis model for men and women separately applied Wilks' lambda, Chi-square and Fisher equation with values of p< 0.05. RESULTS: Of the total sample of patients with DM2, 36.5% were men and 65.5% women with an average age of 58.0 ± 7.8 years. The subclinical atherosclerosis was found in 63.6% (p=0.57), of which 7 developed ischemic heart disease, 20.5% (p=0.57). Globally they change in BMI, HbA1c and serum creatinine with p< 0.05 in monitoring patients to 4 years were observed. As outcome variables were identified: development of ischemic heart disease, angina pectoris, and events cardiovascular adverse mayors in 13.7, 21.6 and 17.6% respectively of the total population. Finally, they were identified as risk factors for developing ischemic heart male gender, presence and years of hypertension and smoking, dyslipidemia and present complications of DM2 all with p< 0.05. CONCLUSION: Long-term studies are required, with a larger number of patients. A case-control study is suggested to determine which type of variables are associated with increased risk of cardiovascular events in diabetic patients.

Simulated Conversations With Virtual Humans to Improve Patient-Provider Communication and Reduce Unnecessary Prescriptions for Antibiotics: A Repeated Measure Pilot Study.

BackgroundDespite clear evidence that antibiotics do not cure viral infections, the problem of unnecessary prescribing of antibiotics in ambulatory care persists, and in some cases, prescribing patterns have increased. The overuse of antibiotics for treating viral infections has created numerous economic and clinical consequences including increased medical costs due to unnecessary hospitalizations, antibiotic resistance, disruption of gut bacteria, and obesity. Recent research has underscored the importance of collaborative patient-provider communication as a means to reduce the high rates of unnecessary prescriptions for antibiotics. However, most patients and providers do not feel prepared to engage in such challenging conversations.ObjectivesThe aim of this pilot study was to assess the ability of a brief 15-min simulated role-play conversation with virtual humans to serve as a preliminary step to help health care providers and patients practice, and learn how to engage in effective conversations about antibiotics overuse.MethodsA total of 69 participants (35 providers and 34 patients) completed the simulation once in one sitting. A pre-post repeated measures design was used to assess changes in patients’ and providers’ self-reported communication behaviors, activation, and preparedness, intention, and confidence to effectively communicate in the patient-provider encounter. Changes in patients’ knowledge and beliefs regarding antibiotic use were also evaluated.ResultsPatients experienced a short-term positive improvement in beliefs about appropriate antibiotic use for infection (F1,30=14.10, P=.001). Knowledge scores regarding the correct uses of antibiotics improved immediately postsimulation, but decreased at the 1-month follow-up (F1,30=31.16, P<.001). There was no change in patient activation and shared decision-making (SDM) scores in the total sample of patients (P>.10) Patients with lower levels of activation exhibited positive, short-term benefits in increased intent and confidence to discuss their needs and ask questions in the clinic visit, positive attitudes regarding participation in SDM with their provider, and accurate beliefs about the use of antibiotics (P<.10). The results also suggest small immediate gains in providers’ attitudes about SDM (mean change 0.20; F1,33= 8.03, P=.01).ConclusionsThis pilot study provided preliminary evidence on the efficacy of the use of simulated conversations with virtual humans as a tool to improve patient-provider communication (ie, through increasing patient confidence to actively participate in the visit and physician attitudes about SDM) for engaging in conversations about antibiotic use. Future research should explore if repeated opportunities to use the 15-min simulation as well as providing users with several different conversations to practice with would result in sustained improvements in antibiotics beliefs and knowledge and communication behaviors over time. The results of this pilot study offered several opportunities to improve on the simulation in order to bolster communication skills and knowledge retention.

(345) Brief psychological screening questions can be useful for ruling out psychological conditions in patients with chronic pain

Psychological co-morbidities or symptoms are highly prevalent in patients with chronic pain, and have been accepted as having an important role in the experience and consequences of pain. Timely and accurate knowledge of the presence or absence of psychological factors may improve patient’s understanding of their own pain condition, better inform clinicians about their individual patients, enable appropriate and individualized treatment, and potentially improve health outcomes. Routine screening may be facilitated through development of brief psychological screening questions with acceptable concurrent validity. The aims of this cross-sectional study were to (i) investigate the concurrent validity of brief psychological screening questions assessing anxiety, fear of movement, stress, pain catastrophization, and depression in chronic pain patients, and (ii) to determine screening question cut-points at which the likely probability of having these psychological states was less than 10%. The responses to one-item or two-item 0-10 screening questions within each of these psychological constructs were compared with validated full-length questionnaires in 894 patients with diverse chronic pain conditions. Compared with scores from full-length questionnaires, brief screening question scores had correlations between 0.54 and 0.66 and AUC between 0.79 and 0.83. For all but fear of movement, we identified threshold scores with acceptable sensitivity and specificity, at which the likely post-test probability of having the psychological state after a negative test was less than 10%. Use of these screening tests and scoring thresholds would have efficiently and correctly identified between a third and two thirds of the total patient sample as being unlikely to have anxiety, stress, pain catastrophization, and depression. These results could have immediate practical application in routine screening of psychological factors allowing clinicians to focus on whether there are other patient attributes in those patients requiring more thorough investigation.

Influence of Underlying Diabetes Mellitus and Hypertension on Blood Pressure Alterations in Japanese Outpatient Cataract Surgery Patients

Background: We gathered data on blood pressure (BP) fluctuations from the period before to the completion of surgery from the medical records of patients undergoing outpatient cataract surgery in Japanese. Methods and findings: The subjects were 1,529 patients (675 men and 854 women) who underwent first-time outpatient cataract surgery under local anesthesia at the Wakayama Medical University Hospital, Japan, between January 2013 and December 2014. The age of the patients ranged from 20 to 95 years (mean: 73.1 ± 9.8 years). Patients taking oral antihypertensive(s) were assigned to a “hypertension group,” and patients receiving medication for diabetes were assigned to a “diabetes group.” BP values 1 h before surgery, upon entering the operating room (OR), and upon completion of surgery and peak intraoperative BP were analyzed. Compared with BP 1 h before surgery, peak systolic BP (SBP) in all patients was significantly elevated upon entering the OR. Compared with the mean SBP of all patients, that of patients with underlying hypertension was higher before surgery, upon entering the OR, during and after surgery. In diabetes patients, SBP 1 h before surgery was not higher than that of the total patient sample; however, it was significantly higher upon entering the OR, during and upon completion of surgery. Discussion: Peak systolic BP was significantly elevated upon entering the OR and during surgery in patients undergoing outpatient cataract surgery. In diabetic patients, no significant differences were noted for SBP 1 h before surgery amongst the entire sample. However, SBP upon entering the OR, during and upon completion of surgery was significantly elevated in these patients compared with that in the entire sample. Particular caution should be paid to BP fluctuations associated with cataract surgery, and a full explanation of the risks of surgery should be given to diabetic patients before surgery.

Response shift – The experience of disease progression in Parkinson disease

ObjectiveTo investigate response shift, the recalibration of perceived quality of life (QoL) relative to symptomatic changes in Parkinson disease (PD). BackgroundHealth-related QoL in PD is influenced by improvement vs. decline in disease severity. However, it is unclear how disease course changes internal standards of QoL over time. Methods124 PD patients were subdivided based on Total UPDRS change over 1 year (stable, improved, declined). The EuroQol Visual Analog Scale assessed QoL at baseline (T1) and 1 year later (T2). At T2, patients rated current QoL (T2-current) and reappraised their T1 QoL (T2-retrospective). Recalibration response shifts were represented by the difference between T1 and T2-retrospective QoL ratings. ResultsAt follow-up (T2), the total patient sample reported no difference between current (T2 current mean (M) = 76.3) and retrospective (T2-R M = 77.8) QoL ratings. While there was no significant difference between T1 (M = 79.2) and T2-R ratings 1 year later (M = 77.8) for the total sample, there was a change by group interaction (p < 0.005) which showed that retrospectively, decliners reduced ratings (M Δ = −9.0) and improvers increased ratings (M Δ = +6.4) while stable patients did not change. ConclusionsWhen PD patients consider their health status one year ago, decliners recalibrate and downgrade last year's health assessment, while improvers upgrade last year's assessment. Changes in internal calibrations cushion periods of decline or improvement in PD such that patients tend to “stabilize” their general disease course when recalling symptom trajectory, providing insight into the process of adaptation to the effects of disease progression and treatment over time.

Postoperative cystographic findings as an independent predictor of urinary incontinence three months after radical prostatectomy.

Postoperative cystogram has been used to identify clinically significant leaks before catheter removal after radical prostatectomy (RP). The aim of the present study was to investigate the relationship between cystogram findings after RP and early urinary incontinence. From January 2011 to February 2015, 417 patients who had undergone a cystography after RP at our hospital were retrospectively analyzed. The ratio dividing the length from the upper part of the pubic symphysis to the neck of the bladder with the length of the total pubic symphysis height (bladder neck pubic symphysis ratio [BNPSR]) was measured and urinary incontinence was assessed by the subjects' use of a pad. In the total patient sample, urinary incontinence 3 months after RP was 28.5%. The mean BNPSR for the group with urinary incontinence and the group without was 0.49±0.26 and 0.38±0.17, respectively (P<0.001). Additionally, the rate of urine leakage in the group with urinary incontinence and the group without was observed to be 14.3% and 6.4% on cystogram, respectively (P=0.012). Open vs. robotic surgeries resulted in urinary incontinence frequencies of 41.0% vs. 22.3% (P<0.001). In a multivariate logistic regression analysis, both a high BNPS ratio (Odds ratio [OR], 23.14; P<0.001) and surgical technique (OR=2.29; P<0.001) were shown to be independent predictive factors for urinary incontinence 3 months after surgery. BNPSR measured by cystogram after RP can be useful for predicting the occurrence of urinary incontinence and managing a patient's progress after RP.

Trait anxiety mediates the effect of stress exposure on post-traumatic stress disorder and depression risk in cardiac surgery patients

BackgroundPost-traumatic stress disorder (PTSD) and depression are common after cardiac surgery. Lifetime stress exposure and personality traits may influence the development of these psychiatric conditions. MethodsSelf-reported rates of PTSD and depression and potential determinants (i.e., trait anxiety and stress exposure) were established 1.5 to 4 years after cardiac surgery. Data was available for 1125 out of 1244 (90.4%) participants. Multivariable linear regressions were conducted to investigate mediating and/or moderating effects of trait anxiety on the relationship between stress exposure, and PTSD and depression. Pre-planned subgroup analyses were performed for both sexes. ResultsPTSD and depression symptoms were present in 10.2% and 13.1% of the participants, respectively. Trait anxiety was a full mediator of the association between stress exposure and depression in both the total cohort and female and male subgroups. Moreover, trait anxiety partially mediated the relationship between stress exposure and PTSD in the full cohort and the male subgroup, whereas trait anxiety fully mediated this relationship in female patients. Trait anxiety did not play a moderating role in the total patient sample, nor after stratification on gender. LimitationsThe unequal distribution of male (78%) and female patients (22%) might limit the generalizability of our findings. Furthermore, risk factors were investigated retrospectively and with variable follow-up time. ConclusionsIn cardiac surgery patients, trait anxiety was found to be an important mediator of postoperative PTSD and depression. Prospective research is necessary to verify whether these factors are reliable screening measures of individuals' vulnerability for psychopathology development after cardiac surgery.

Effects of socioeconomic status on physical and mental health of hemodialysis patients in Japan: differences by age, period, and cohort.

Study purposeWhether or not socioeconomic status (SES)-related differences in the health of hemodialysis patients differ by age, period, and birth cohort remains unclear. We examined whether SES-related gaps in physical and mental health change with age, period, and birth cohort for hemodialysis patients.MethodsData were obtained from repeated cross-sectional surveys conducted in 1996, 2001, 2006, and 2011, with members of a national patients’ association as participants. We used raking adjustment to create a database which had similar characteristics to the total sample of dialysis patients in Japan. SES was assessed using family size-adjusted income levels. We divided patients into three groups based on their income levels: below the first quartile, over the second quartile and under the third quartile, and over the fourth quartile. We used the number of dialysis complications as a physical health indicator and depressive symptoms as a mental health indicator. We used a cross-classified random-effects model that estimated fixed effects of age categories and period as level-1 factors, and random effects of birth cohort as level-2 factors.ResultsRelative risk of dialysis complications in respondents below the first quartile compared with ones over the fourth quartile was reduced in age categories >60 years. Mean differences in depressive symptoms between respondents below the first quartile and ones over the fourth quartile peaked in the 50- to 59-year-old age group, and were reduced in age groups >60 years. In addition, mean differences varied across periods, widening from 1996 to 2006. There were no significant birth cohort effects on income differences for dialysis complications or depressive symptoms.ConclusionThe number of dialysis complications and depressive symptoms in dialysis patients were affected by income differences, and the degree of these differences changed with age category and period.

Mental health and drug

IntroductionBipolar disorder (BD) is often associated with various comorbidities. It is substance use disorders (SUD) one of the most frequent comorbidities.The ECA study (Epidemiologic Catchment Area) observed a prevalence over the life of the 56, 1% for any TUS in the total sample of patients with bipolar disorder. In subjects with bipolar I disorder prevalence was 60.7%, and those of type II 48.1.In the OMS study conducted in America, Europe and Asia, the results confirm the high rates of disorders in patients diagnosed with bipolar disorder regardless of the country of study.CaseThis is a male, 32, who came first to the Provincial Drug Addiction Service of Huelva in 2009 for cocaine, cannabis and alcohol.In his personal history, he relates a convulsive episode at 14 years and one manic episode associated with consumption of cocaine in 2002 which began to be treated by a team of Mental Health and Provincial Center for Addictions.He entered twice in a therapeutic community in 2009 for treatment for their disorder dependence on cocaine, alcohol and cannabis.It has required admission to the Unit Hospitalization twice in 2012, with the discharge diagnosis of manic episode secondary to drug consumption.ConclusionsMost epidemiological studies in recent decades note the high prevalence of comorbidity BD + SUD.BD-SUD comorbidity is particularly complex because each disorder affects the evolution of the other and they are frequently multiple comorbidities. In addition, it implies a worse clinical and functional outcome as well as poorer therapeutic response.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Agreement between clinical judgments and subjective perceptions of clinical change

IntroductionResearch into the relationship between the subjective perception of clinical change and the objective evidence of the same is very limited. Less is known about the relationship between clinical judgments by mental health experts and the patient's perception of symptom change, in particular across different diagnostic groups.Aims and objectivesThis study aims to determine the level of concordance between the HONOS as a tool for clinical outcome monitoring and the self-reported change in psychopathology in a total sample of psychiatric patients as well as stratified by their primary diagnosis at admission.MethodsA consecutive sample of patients admitted to a Swiss psychiatric hospital for either alcohol use disorders, schizophrenic psychoses, mood disorders, anxiety and somatoform disorders, or personality disorders, was assessed using the Brief Symptom Inventory (BSI) at admission and at discharge. The HoNOS were rated by the responsible clinicians. Complete data of admission and discharge were available from approximately 600 cases. Reliable change index (RCI) will be calculated to determine a clinically meaningful change based on the HoNOS scores. Concordance of RCI and change in BSI scores will be explored and compared between different diagnostic groups.Results and conclusionsAccording to our preliminary results from this ongoing evaluation program, we hope to provide a step towards a deeper understanding of the interrelationship between clinical judgments and the course of subjectively experienced mental health problems.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Descriptive study of mechanical restraint in acute psychiatric inpatient unit of Jerez De La Frontera: Analysis of a risk profile

IntroductionVarious medical and psychiatric conditions can determine the occurrence of disruptive behavior and aggression. Mechanical restraint is part of the strategies for managing these risks. Its use implies a multidisciplinary, phased and individualized for each case strategy, with attention to the ethical and legal issues surrounding this coercive intervention.ObjectiveThe objective of this work is the analysis of the profile of patients who required mechanical restraint during hospitalization in a psychiatric inpatient unit.MethodologyRetrospective descriptive analysis by collecting data of patients, who required mechanical restraint during admission, between 2007 and 2014. The data sources were medical clinical history and nursing records. Variables analyzed were sex, age, clinical diagnosis at discharge and clinical state during the episode of mechanical restraint.ResultsOf the total sample of patients requiring restraint (n = 266), 66.92% were men. The mean age of patients was 38.01 years. Distribution of clinical diagnoses based on ICD-10 coding: 30.23% F60 personality disorder (n = 289), 19.56% diagnosed with F31 bipolar disorder (n = 187) and 14.02% F20 schizophrenia. Regarding the clinical characteristics of the episode, 49.47% of patients had an agitation/violent state and in 23.11% risk of impulsive self-injury was evident, 13.47% had confusional syndrome.ConclusionData analyzed shows differences in frequency distribution because of patient profile and clinical diagnosis. Otherwise, organizational factors and appropriate amendments to this level appear to play a key role in minimizing the use of such coercive measures.Disclosure of interestThe authors have not supplied their declaration of competing interest.