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PubMed2006

Development and validation of a patient-centred Measure of Activity Limitation (MAL) in rheumatoid arthritis.

OBJECTIVE: This study sought to understand patients' experiences of activity limitation in rheumatoid arthritis (RA) to inform the development and preliminary validation of a new patient-centred assessment tool. METHODS: Interviews, focus groups and diaries provided insight into patients' experiences of change in activity limitation. These data informed item generation for the Measure of Activity Limitation (MAL) questionnaire. Postal surveys, comprising the MAL, Short Form 36 (SF36) and Health Assessment Questionnaire (HAQ), were used to inform item reduction and assess the MAL's validity, reliability and sensitivity. RESULTS: Qualitative exploration of activity limitation with 30 patients led to the development of a 36-item questionnaire addressing the impact of symptoms on activity, difficulty in global function and difficulty in task performance. Analysis of data from a postal survey of 168 patients led to the development of a 19-item questionnaire which demonstrated moderate correlations with the HAQ and relevant scales of the SF36. A second postal questionnaire, completed on two occasions by 308 patients, assessed test-retest reliability. One hundred and ninety-three people reporting no change in disease showed mean change in MAL score between the two completions of 0.41 [95% confidence interval (CI) -0.38 -1.22)], demonstrating test-retest reliability. Thirty-two patients reporting improvement showed a mean change of -7.84 (95% CI -11.15 to -4.54) and 83 reporting deterioration showed mean change of 4.63 (95% CI 3.09-6.16), suggesting that the MAL is sensitive to self-reported clinical change. CONCLUSION: Our results suggest that the MAL is valid, reliable and sensitive to self-reported change. The MAL may provide a useful patient-centred adjunct to existing measures of activity limitation.

Adult↗

PubMed2004

ANDI-03: a genetic algorithm tool for the analysis of activation detector data to unfold high-energy neutron spectra.

The thresholds of (n,xn) reactions in various activation detectors are commonly used to unfold the neutron spectra covering a broad energy span, i.e. from thermal to several hundreds of MeV. The saturation activities of the daughter nuclides (i.e. reaction products) serve as the input data of specific spectra unfolding codes, such as SAND-II and LOUHI-83. However, most spectra unfolding codes, including the above, require an a priori (guess) spectrum to starting up the unfolding procedure of an unknown spectrum. The accuracy and exactness of the resulting spectrum primarily depends on the subjectively chosen guess spectrum. On the other hand, the Genetic Algorithm (GA)-based spectra unfolding technique ANDI-03 (Activation-detector Neutron DIfferentiation) presented in this report does not require a specific starting parameter. The GA is a robust problem-solving tool, which emulates the Darwinian Theory of Evolution prevailing in the realm of biological world and is ideally suited to optimise complex objective functions globally in a large multidimensional solution space. The activation data of the 27Al(n,alpha)24Na, 116In(n,gamma)116mIn, 12C(n,2n)11C and 209Bi(n,xn)(210-x)Bi reactions recorded at the high-energy neutron field of the ISIS Spallation source (Rutherford Appleton Laboratory, UK) was obtained from literature and by applying the ANDI-03 GA tool, these data were used to unfold the neutron spectra. The total neutron fluence derived from the neutron spectrum unfolded using GA technique (ANDI-03) agreed within +/-6.9% (at shield top level) and +/-27.2% (behind a 60 cm thick concrete shield) with the same unfolded with the SAND-II code.

Algorithms↗

PubMed2006

The Illness Management and Recovery program: rationale, development, and preliminary findings.

The Illness Management and Recovery (IMR) program was developed based on a comprehensive review of research on teaching illness self-management strategies to clients with schizophrenia and other severe mental illnesses and "packaged" in a resource kit to facilitate dissemination. Despite growing dissemination of this program, it has not yet been empirically validated. This article describes the development and theoretical underpinnings of the IMR program and presents pilot data from the United States and Australia (N = 24, 88% schizophrenia or schizoaffective) on the effects of individual-based and group-based treatment over the 9-month program and over a 3-month follow-up. High satisfaction was reported by participants. Strong improvements over treatment and at follow-up were found in clients' self-reported effectiveness in coping with symptoms and clinicians' reports of global functioning and moderate improvements in knowledge about mental illness, distress related to symptoms, hope, and goal orientation. These findings support the feasibility and promise of the IMR program and point to the need for controlled research to rigorously evaluate its effects.

Adolescent↗

PubMed1987

Hypothyroid cardiomyopathy: echocardiographic documentation of reversibility.

The concept of hypothyroid heart disease remains controversial. Although hemodynamic abnormalities have been described, the presence of underlying abnormal cardiac structures has not been confirmed. The authors studied 20 hypothyroid patients using M-mode echocardiography before and after l-thyroxine therapy. Fifteen additional hypothyroid patients were studied using two-dimensional echocardiography to confirm the data of the first study. The findings were the same in both studies: during hypothyroidism, the interventricular septum is thickened, the ratio of septal thickness to left ventricular posterior wall thickening is increased, the right ventricular wall is thickened, regional wall motion of interventricular septum and right ventricular wall is decreased, and global function of the left ventricle is decreased. These findings are reversed with l-thyroxine therapy; they occur within 6 months of the development of hypothyroidism, but appear unrelated to elevated TSH levels. Whether the thickened interventricular septum and right ventricular wall represent true muscular hypertrophy requires further elucidation. Nevertheless, these data demonstrate the existence of a hypothyroid cardiomyopathy.

Adult↗

PubMed1996

Acoustic quantification: a new tool for diagnostic echocardiography.

Acoustic quantification, a new ultrasound technique, provides a more direct assessment of the health of the myocardium than conventional echocardiography. Through software enhancements, acoustic quantification can characterize the myocardium as viable or nonviable, automatically track the endocardium throughout the cardiac cycle, and show myocardial perfusion defects when used with contrast enhancement. Thus, this technique shows promise in linking perfusion, viability, and global function in adults and perhaps in children.

Animals↗

PubMed1996

In vitro comparison of the effects of contrast media on coagulation and platelet activation.

The aim of this study was to compare the in vitro effects of different classes of contrast media on both the blood coagulation system and on platelet function. Global tests (APTT, TT) and FpA and F1 + 2 generation measurements showed that ioxaglate (ionic dimer) presents the highest anticoagulant potential. The anticoagulant effects of nonionic agents were less marked, iodixanol (nonionic dimer) being significantly less anticoagulant than iohexol (nonionic monomer). Major platelet activation was observed with release of PF4, serotonin and PDGF-AB when iohexol was incubated for 1 min in whole blood. Iodixanol showed no effect over the same period, while moderate platelet activation was observed after 30 min. Under the same experimental conditions, ioxaglate had no effect on platelets even after incubation for 30 min, whereas activation was observed with 9 g/l saline control at this time. Prevention of thrombin formation and platelet activation is only achieved with ioxaglate, the ionic dimer. These findings may be clinically important in the thrombotic environment of radiological procedures and may explain the increased thrombotic risks observed with nonionic agents in interventional procedures.

Blood Coagulation↗

PubMed1997

A specific deficit of dorsal stream function in Williams' syndrome.

Williams' syndrome (WS) is a rare, genetically based disorder of cognitive development. Affected individuals show a severe deficit of spatial cognition but a relative sparing of language and face recognition. To examine the possible neural basis of the spatial deficit, we tested a group of WS children, aged 4-14 years, on two measures specific to dorsal cortical stream function: global motion coherence thresholds, in comparison with an analogous form-coherence test, and visuo-manual accuracy in posting a card through a slot, compared with matching the slot orientation. Deficits in these tasks provide the first evidence of specific involvement in WS of the dorsal stream, the cortical system believed to encode information about spatial relationships and the visual control of action.

Adolescent↗

PubMedDate not supplied

A prospective 5-year follow-up study on the behavioral disturbances of community-dwelling elderly people with Alzheimer disease.

The aim of the present study was to determine the longitudinal course of behavioral disturbances and to examine whether these disturbances are stage dependent during the course of Alzheimer disease (AD). One hundred seven community-dwelling patients with probable AD were assessed up to six times annually by using a validated and reliable rating scale, the Troublesome Behavior Scale, for assessing the frequencies of behavioral disturbances. The subjects were divided into three groups according to their baseline global function as assessed by the Clinical Dementia Rating (CDR; 1 = mild, 2 = moderate, 3 = severe). At the end of the 5-year observation period, 31 subjects were still active participants, 52 had died, 20 lived in institutions, and 4 had stopped participating. The patterns of their behavioral disturbance changes depended to a considerable extent on the baseline severity of the illness. The behavioral disturbance frequencies generally peaked at the CDR 2 stage and followed a downward trend thereafter. Considerable individual variations in the disturbance frequencies during the course of the illness were observed. Knowing the behavioral course of AD will enable clinicians to better counsel families and appraise the results of treatments for behavioral symptoms.

Aged↗

PubMedDate not supplied

Galantamine demonstrates efficacy and safety in elderly patients with Alzheimer disease.

Alzheimer disease (AD) treatment guidelines state that cholinergic agents are not cost-effective in patients with more severe disease. Because many physicians may deem an older patient unlikely to respond to treatment, older AD patients may remain untreated. Galantamine (Reminyl), a novel cholinergic agent, is effective in mild to moderate AD. This post hoc analysis of pooled phase III galantamine clinical trials was designed to assess whether older (> or =80 years) and younger (< or =79 years) AD patients experience similar benefits with galantamine based on changes in the ADAS-cog and CIBIC-plus. Mean ADAS-cog scores for older patients treated with galantamine 24 mg/day significantly improved versus baseline and versus placebo at month 3. Cognitive improvement was maintained versus placebo at month 6; the ADAS-cog score for placebo patients dropped below baseline at month 6. Change in CIBIC-plus for galantamine was significantly different from placebo at months 5 to 6. Mean ADAS-cog score in older patients taking galantamine for 12 months remained above baseline. The score for patients taking placebo for 6 months before switching to galantamine did not differ significantly from baseline at 12 months but was lower than in patients receiving galantamine for 12 months. Incidence of adverse events in patients > 80 years was similar to that in the overall study population. Galantamine maintained cognitive and global function in patients > 80 years with mild to moderate AD for at least 5 to 6 months and cognitive efficacy for 12 months. Prescribing approved therapies such as galantamine for older patients with AD is recommended.

Age Factors↗

PubMedDate not supplied

Treatment effect size of memantine therapy in Alzheimer disease and vascular dementia.

The purpose of this paper is to assess the clinical relevance of the significant results reported in clinical trials of memantine therapy for Alzheimer disease (AD) and vascular dementia. We sought to understand what clinically detectable changes would be evident to the patient with dementia, their caregivers, and the treating physician during a trial of memantine therapy. A literature search was performed on MedLine, PsycInfo, and the Cochrane database. The statistically significant findings from the memantine literature were reviewed using treatment effect size as a measure of clinical meaningfulness. There have been 3 phase 2 studies of memantine in dementia, and 6 phase 3 studies published as of August 1, 2005. Of the 6 published phase 3 trials of memantine in dementia; 2 were in mild-moderate vascular dementia, 1 in mild-moderate AD, 2 in moderate-severe AD, and 1 in severe dementia (both AD and vascular dementia). The most convincing evidence of a clinically meaningful treatment effect of memantine therapy is in the moderate-severe AD patient population. Cognition, as measured by the Severe Impairment Battery, had an effect size of 0.32 and 0.49 in the 2 published trials, indicating a small-to-medium effect of the medication. Global, functional, and behavioral scales also showed a small-to-medium response to memantine.

Alzheimer Disease↗

PubMed1990

The epidemiology of childhood psychiatric disorders: prevalence findings from recent studies.

While sharing a new emphasis upon identifying discrete psychiatric disorders in children and adolescents, epidemiological field studies conducted during the past decade have used diverse methods of case ascertainment and definition. Half used the multimethod-multistage approach to ascertain cases. Severity rating scales and measures of pervasiveness, parent-child concordance, and global functional impairment were employed to enhance the specificity of case definition. The majority of overall prevalence estimates of moderate to severe disorder range from 14 to 20%. Those investigations that use multiple methods to define caseness show greatest promise in identifying true cases in community samples.

Adolescent↗

PubMed1995

Unipolar depression in adolescents: clinical outcome in adulthood.

OBJECTIVE: This study examined the longitudinal clinical course and adult sequelae of adolescent unipolar major depressive disorder (MDD) using a controlled longitudinal design. METHOD: Subjects were 28 adolescents (15.4 +/- 1.3 years) with systematically diagnosed unipolar MDD and 35 group-matched control subjects who participated in a cross-sectional electroencephalogram sleep and neuroendocrine study. Using standardized instruments, interviewers who were blind to subjects' initial diagnoses conducted follow-up clinical assessments 7.0 +/- 0.5 years later in 94% of the original cohort. RESULTS: The depressed group showed high rates of recurrence of MDD episodes during the interval period (69%). They also had elevated rates of new-onset bipolar disorder (19%). Twenty-three percent of subjects with an initial diagnosis of MDD had no additional depressive episodes after the index assessment. The rate of new onset of depression in the controls was 21%. Low socioeconomic status predicted recurrence of depressive episodes in the MDD group. MDD subjects with recurrence(s) and controls with new onset of depression during the follow-up period had significant psychosocial morbidity, as evidenced by disruption in interpersonal relationships and dissatisfaction with life and decrease in global functioning, compared with both MDD subjects with no further episodes and control subjects who had never been psychiatrically ill. These psychosocial deficits persisted remission from depressive episode(s). CONCLUSIONS: Adolescent unipolar MDD predicts continued risk for recurrences with persistence of depressive episodes and psychosocial morbidity into adulthood. A sizable minority, however, have sustained periods of remission associated with good social adjustment.

Adolescent↗

PubMed1996

A comparison of measures of adjustment, symptoms, and impairment among children with chronic medical conditions.

OBJECTIVE: To examine the concurrent and criterion validity of three instruments used to measure emotional and behavioral problems among children with chronic illness. METHOD: The Personal Adjustment and Role Skills Scale (PARS III), Child Behavior Checklist (CBCL), and Columbia Impairment Scale (CIS) were compared with each other and with structured interview-derived psychiatric diagnoses in 116 chronically ill children, aged 9 to 18 years. Three cutoff scores were used for each measure. RESULTS: The measures had good concurrent validity despite only moderate agreement with each other. Their criterion validity was only fair: levels of sensitivity were fair at low cutoffs and poor at standard and high cutoffs; specificity and positive predictive values rose from moderate at low cutoffs to high at standard and high cutoffs. The agreement between the scales and a mental disorder diagnosis was only moderate at any of the cutoff points. CONCLUSIONS: Each of these measures has significant limitations. Both the CBCL and the PARS III appear to measure similar constructs but are likely to underidentify medically ill children with comorbid psychiatric problems. Consideration of global functioning across domains, with a measure such as the CIS, might provide an alternative approach to behavioral and symptom checklists in the assessment and management of children with chronic conditions.

Adolescent↗

PubMed1998

Cognitive-behavioral treatment of school-refusing children: a controlled evaluation.

OBJECTIVE: To evaluate the efficacy of a 4-week cognitive-behavioral treatment program for children who refuse to go to school. METHOD: Thirty-four school-refusing children (aged 5 to 15 years) were randomly assigned to a cognitive-behavioral treatment condition or a waiting-list control condition. Treatment consisted of individual child cognitive-behavioral therapy plus parent/teacher training in child behavior management skills. Measures taken before and after treatment included school attendance, child self-report of emotional distress and coping, caregiver reports on emotional and behavioral problems, and clinician ratings of global functioning. RESULTS: Relative to waiting-list controls, children who received cognitive-behavioral therapy exhibited a significant improvement in school attendance. These children also improved on self-reports of fear, anxiety, depression, and coping. Significant improvements also occurred in relation to caregiver reports and clinician ratings. Maintenance of therapeutic gains was demonstrated at a 3-month follow-up assessment. CONCLUSIONS: Cognitive-behavioral treatment of school refusal was efficacious and acceptable. The relative contributions of child therapy and parent/teacher training require further study.

Adolescent↗

PubMed2000

Treating sexually abused children with posttraumatic stress symptoms: a randomized clinical trial.

OBJECTIVE: To evaluate the efficacy of child and caregiver participation in the cognitive-behavioral treatment of sexually abused children with posttraumatic stress symptoms. METHOD: Thirty-six sexually abused children (aged 5-17 years) were randomly assigned to a child-alone cognitive-behavioral treatment condition, a family cognitive-behavioral treatment condition, or a waiting-list control condition. RESULTS: Compared with controls, children who received treatment exhibited significant improvements in posttraumatic stress disorder symptoms and self-reports of fear and anxiety. Significant improvements also occurred in relation to parent-completed measures and clinician ratings of global functioning. In general, parental involvement did not improve the efficacy of cognitive-behavioral therapy. Maintenance of improvement was evident at a 12-week follow-up assessment. CONCLUSIONS: Cognitive-behavioral treatment was useful, but further research is required on caregiver involvement.

Adolescent↗

PubMed1995

Temperament, character, and personality disorder in bulimia nervosa.

In a sample of 76 women participating in a clinical treatment trial for bulimia nervosa, we examined the clinical differences between subjects with and without concurrent personality disorders and the ability of "self-directedness" (a character scale of Cloninger's Temperament and Character Inventory) to predict the presence of personality disorder. Sixty-three percent of the sample had at least one personality disorder diagnosis. Fifty-one percent of personality disorders were in cluster C, 41% were in cluster B, and 33% were in cluster A. The presence of personality disorder was associated with greater depressive symptoms, worse global functioning, laxative use, greater body dissatisfaction, higher harm avoidance, and lower self-directedness. As hypothesized, low self-directedness scores were associated with a markedly increased probability of a personality disorder.

Adult↗

PubMed1999

Assessing clinical predictions of early rehospitalization in schizophrenia.

This study determines patient characteristics that predict early hospital readmission in schizophrenia and evaluates the extent to which inpatient staff accurately predict these readmissions. Adult inpatients with schizophrenia or schizoaffective disorder (N = 262) were evaluated at hospital discharge and 3 months later to assess hospital readmission. At hospital discharge, inpatient staff were asked to identify which patients were likely to be readmitted during this period. Comparisons were made between patients who were or were not readmitted and between readmitted patients who were or were not identified by staff as likely to be readmitted; 24.4% of the sample were readmitted within 3 months of hospital discharge. Early readmission was associated with four or more previous hospitalizations (85.7% vs. 57.7%, p = .004), comorbid substance use disorder (60.3% vs. 35.5%, p = .0006), major depression (40.6% vs. 26.8%, p = .04), absence of a family meeting with inpatient staff (58.2% vs. 41.8%, p = .02), and prescription of a conventional rather than an atypical antipsychotic medication (93.7% vs. 83.8%, p = .045). Twelve of the 63 readmitted patients were correctly predicted by staff to re-hospitalize. Staff tended to overestimate the risk of rehospitalization in patients with a poor therapeutic alliance, low global function, or initial involuntary admission and to underestimate the risk in patients with alcohol use disorders or four or more previous psychiatric hospitalizations. Early rehospitalization is common in schizophrenia and difficult to predict. Greater emphasis on comorbid alcohol use disorders and a history of multiple previous admissions may help clinicians identify patients at greatest risk for early rehospitalization.

Adult↗

PubMed1998

Beta-adrenergic stimulation of reperfused myocardium after 2-hour ischemia.

Postischemic myocardium possesses considerable contractile and metabolic reserves, but their mobilization could result in increased cell death. We tested the hypothesis that beta-adrenergic stimulation of reperfused myocardium would increase segment work more than O2 consumption, thereby improving efficiency without increased cell death. In 16 open-chest anesthetized dogs, the left anterior descending coronary artery (LAD) was ligated for 2 h; during the reperfusion period, isoproterenol (ISO; 0.1 microg/kg/min, i.v.) was administered to nine of the animals. Regional myocardial segment length and force were measured in the anterior (LAD) and posterior circumflex coronary artery (CFX) regions of the left ventricular myocardium. Work was calculated as the integrated products of force and shortening for each region. Regional myocardial O2 consumption was obtained from LAD flow and arterial and local venous O2 saturations. Infarct size (tetrazolium) was measured in the treated and untreated hearts at the end of the experiment. In untreated hearts, the first derivative of left ventricular pressure, cardiac output, and external work were significantly depressed during reperfusion; ISO restored all values to preocclusion levels. Regional myocardial work in both LAD and CFX regions was significantly increased by ISO (from 564 +/- 207 to 1,635 +/- 543 g/mm/min in LAD, and from 753 +/- 90 to 1,426 +/- 245 g/mm/min in CFX). Efficiency (work/oxygen consumption) of the reperfused region was similarly increased. LAD flow was significantly increased by ISO, and O2 extraction was unchanged. Infarct size was 28.2 +/- 4.7% in untreated hearts and 29.0 +/- 3.5% in ISO hearts. Thus isoproterenol stimulation significantly improved both regional and global function without subsequent evidence of increased cell death.

Adrenergic beta-Agonists↗